Philadelphia College of Osteopathic Medicine
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A review of AI integration in personalized nutrition: advancements, challenges, and clinical implications
No full textIntroduction Artificial intelligence (AI) is transforming healthcare, including the intersection of nutrition and medicine. Personalized dietary recommendations play a crucial role in managing chronic diseases such as diabetes, cardiovascular conditions, and obesity. AI-driven tools offer the potential to enhance dietary assessments and optimize meal planning based on individual needs. However, ethical and practical challenges remain. This study explores the question: How can AI enhance personalized nutrition recommendations while addressing ethical and practical challenges in clinical applications?
Methods A systematic literature review was conducted, analyzing research from databases such as PubMed and Google Scholar. Studies were selected based on relevance to AI-driven dietary analysis, machine learning in meal planning, and clinical applications. Key themes examined included:
AI-driven real-time dietary assessment and its clinical accuracy.
Machine learning algorithms for personalized meal planning and adherence monitoring.
Implementation of AI-powered applications in clinical nutrition and medicine.
Ethical concerns, algorithmic bias, and regulatory barriers in AI-driven nutrition.
Results & Discussion AI-driven personalized nutrition systems show promising capabilities including:
Real-time dietary assessment through food tracking applications and wearable sensors.
Machine learning-based meal planning to tailor recommendations to an individual’s health profile.
Improved patient adherence facilitated by AI-powered apps that provide feedback and reminders.
Despite these advancements, several challenges must be addressed:
Algorithmic bias: Many AI models are trained on non-diverse datasets, potentially leading to recommendations that do not accommodate different ethnic or socioeconomic groups.
Data privacy and security: The use of personal health data in AI applications raises concerns about confidentiality and protection.
Clinical validation and regulatory barriers: The lack of standardized validation methods limits AI’s acceptance in medical practice.
Ethical considerations are central to AI’s integration in clinical practice. Transparency in AI decision-making is necessary to maintain trust, and disparities in AI-generated recommendations must be addressed. Seamless integration into clinical workflows requires interdisciplinary collaboration among healthcare professionals, AI developers, and policymakers.
Conclusion & Future Directions AI has the potential to transform personalized nutrition and chronic disease management. However, ethical concerns and regulatory challenges must be addressed to ensure safe and equitable adoption. Future research should focus on developing inclusive AI models, conducting real-world clinical trials, and integrating AI-driven nutrition recommendations into clinical guidelines. Establishing regulatory oversight will be essential for responsible AI implementation in healthcare
The Role of Hoxa11 and Hoxd11 Expression Patterns in Determining Calcaneus Shape in Mice
No full textINTRODUCTION: Hox genes play a vital role in skeletal development in the embryo and continue to function in the maintenance and repair of bone throughout life. In embryonic development, Hoxa11 and Hoxd11 genes are expressed near the developing ankle, specifically the calcaneus. Previous studies demonstrate that mice with various combinations of Hoxa11 and Hoxd11 loss-of-function mutations exhibit statistically significant calcaneus shape differences compared to the wild-type. However, the detailed expression patterns of these two genes have not been thoroughly characterized in the calcaneus and surrounding tissues.
OBJECTIVES: The present study aims to compare the expression patterns of Hoxa11 and Hoxd11 in and around the developing calcaneus. We compared the regions of gene expression in wild-type mice to known shape differences that were identified in previous studies in calcanei of mice with Hoxa11 and Hoxd11 loss-of-function mutations.
METHODS: We conducted RNAscope™ in situ hybridization to localize Hoxa11 and Hoxd11 mRNA expression in histological sections of wild-type mouse hind paws at postnatal days (P)0, P4, P9. Histological slides were scanned using a Motic slide scanner, and Motic imaging software was used to compare Hoxa11 and Hoxd11 gene expression in and around the calcaneus.
RESULTS: Hoxa11 expression is strong throughout the calcaneus and surrounding tissue, including in the perichondrium and chondrocytes. Several anatomical locations exhibit increased staining intensity, including the perichondrium of the calcaneal tuberosity and regions of the sustentaculum tali. Hoxd11 expression was minimal in and around the calcaneus; however, expression was observed in the calcaneal tendon, and near the site of insertion into the calcaneal tuberosity. These expression patterns correspond to shape changes observed in previous studies of mice with Hoxa11 and Hoxd11 loss-of-function mutations, whereby knocking out Hoxa11 resulted in shortened calcaneal tuberosity and reduced size of the sustentaculum tali.
Conclusion: The widespread Hoxa11 expression seen in wild-type mice identifies Hoxa11 as a substantial contributor to calcaneus development. The overlap of morphological changes in Hoxa11 knockout mice with the distribution of Hoxa11 gene expression in the wild-type calcaneus further supports the role of Hoxa11. Moreover, these data suggest a reduced role of Hoxd11 in determining calcaneus shape and morphology, although further investigation is needed to assess the interaction between these two genes. Understanding the differential expression of Hoxa11 and Hoxd11 in the calcaneus may provide insight into their distinct functions in bone formation and development
Management of ectopic pregnancy in a 34-year-old female
Full text linkIntroduction: Ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity, most commonly in the fallopian tube. This condition can lead to life-threatening complications if not promptly diagnosed and managed. This case report presents a 34-year-old woman with symptomatic right ectopic pregnancy, who presented with abdominal pain, vaginal bleeding, and signs of internal bleeding.
Objective: The objective of this case study is to illustrate the surgical management of a right ectopic pregnancy using a tissue-sparing hydro-dissection technique and its impact on preserving future fertility.
Methods: The patient presented with right lower quadrant pain, cervical motion tenderness, and an empty uterus on ultrasound. A 4 cm right adnexal mass and free fluid were identified, suggesting an ectopic pregnancy with potential internal bleeding. Emergency laparoscopy was performed, during which a linear incision was made on the right fallopian tube. Hydro-dissection was employed to minimize bleeding and tissue trauma, followed by removal of the ectopic tissue. The fallopian tube was preserved, and the abdomen was irrigated to remove blood.
Results: The patient recovered well postoperatively and had a negative pregnancy test one week after surgery. She was counseled about the risk of recurrent ectopic pregnancies. Within six months, the patient conceived an intrauterine pregnancy, successfully delivered a healthy child, followed by another healthy pregnancy two years later. The hydro-dissection technique played a key role in preserving the fallopian tube, enabling future fertility.
Conclusion: This case demonstrates the importance of timely surgical intervention in ectopic pregnancy to prevent life-threatening complications. The use of tissue-sparing techniques, such as hydro-dissection, can help preserve the fallopian tube and support future fertility, as evidenced by the patient’s subsequent successful pregnancies. Early diagnosis and appropriate management are critical in optimizing reproductive outcomes for women with ectopic pregnancies
Thickened skull found in case study with history of metastatic brain cancer
Full text linkIntro
A 21-year-old female was found to have thickened parietal bones and abnormal calvaria during a routine anatomy dissection. She was diagnosed with a malignant brain tumor, although the specific type of tumor was not identified. Skull thickening associated with brain tumors occurs due to pressure from the tumor, which stimulates bone growth. Other conditions that can lead to skull thickening include meningiomas, tuberous sclerosis, skeletal dysplasias, and acromegaly.
Methods
In the gross anatomy lab, thickening of the skull was observed during routine dissection. Permissions were secured from the body donation program and the donor\u27s family to document and publish the findings for education. Soft tissues and the brain were removed from the skull. The skull was treated with a small amount of lye to help clean the skull for examination. The pathology was measured with calipers and photographed for further analysis.
Results
The right parietal bone was significantly thicker than the left parietal bone (7.2 mm and 5.8 mm, respectively). All other skull thickness measurements were the normal ranges.
Discussion
Our case highlights a 21-year-old female donor exhibiting parietal bone thickening, likely due to her history of malignant brain neoplasms. Skull thickening near tumor sites is common, resulting from tumor pressure that stimulates osteoblast activity. This case provides valuable insight into how malignant brain tumors and other conditions can cause skull thickening. Using skull measurements, clinicians can better understand these pathologies and assess outcomes related to malignant tumors and other causes of skull thickening
Recently reported adverse effects of miscellaneous antibiotics
Full text linkPurpose
Antibiotics are utilized for the treatment of various infections though they are not used entirely without any safety concerns. Antibiotics are known to be associated with various adverse effects and literature review can be utilized in not only learning about these adverse effects but also how to manage them. Our research focuses on the adverse effects published in the literature during 2023 on multiple antibiotic drug classes. The purpose of this review is to provide an updated collection of information to healthcare professionals from all disciplines on both pre-existing and new or uncommon side effects of antibiotics.
Methods
A list of antimicrobial agents were separated into six different classes plus a miscellaneous category. Electronic databases such as PubMed, Science Direct, and Google Scholar were used to analyze articles published between January to December of 2023. MESH search terms were utilized to further specify each separate antimicrobial pharmacologic class via the word “adverse effects”. A total of 100 articles were found to be relevant and utilized in our review. The filtered articles were meticulously assessed and were summarized and arranged according to prespecified antimicrobial classes including glycopeptides, oxazolidinones, macrolides, lincosamides, fluoroquinolones, and aminoglycosides along with miscellaneous antibiotics including metronidazole, nitrofurantoin, sulfamethoxazole/trimethoprim, and daptomycin. Commonly known adverse effects were reported on but the focus was on those that are severe and rare.
Results
Within the 100 articles found, most contained one adverse event per article, though there were a few articles that contained more than one adverse event for the drug being studied. Of the body systems, hepatic, renal and hematologic systems were found to be most affected by these classes of antibiotics. Glycopeptides, fluoroquinolones and aminoglycosides were the drug classes most frequently seen with adverse effects, with 24 articles representing adverse effects from glycopeptides, 16 articles representing fluoroquinolone adverse effects, and 14 articles representing aminoglycoside adverse effects. Specific agents seen with the most adverse effects were vancomycin with a total of 19 reported adverse effects and metronidazole and sulfamethoxazole-trimethoprim with 11 reported adverse effects each.
Conclusion
Antibiotics play a crucial role in treating bacterial infections, but their use is not without risks. Adverse effects can range from mild reactions to severe complications, such as allergic responses or antibiotic resistance. Understanding these potential adverse effects is essential for using them responsibly. Education on side effects plus careful prescribing practices can maximize the benefits of antibiotics while minimizing their risks where we can ultimately enhance treatment outcomes for patients and reduce issues such as antimicrobial resistance
The Impact of Artificial Turf versus Natural Grass on Anterior Cruciate Ligament Injury Rates in Football and Soccer: A Scoping Review
Full text linkBackground: The widespread adoption of artificial turf in professional and collegiate football and soccer has raised concerns about its influence on anterior cruciate ligament (ACL) injury rates. While artificial surfaces may increase lower extremity injury risk due to greater surface friction and cleat-turf interaction, some studies report no significant difference compared to natural grass. This review assesses the correlation between playing surface types and ACL injury incidence in football and soccer athletes.
Methods: A comprehensive literature review was conducted in November 2024 across PubMed, Embase, Scopus, and Google Scholar using terms such as “ACL injury,” “artificial turf,” “natural grass,” and “FieldTurf.” Studies comparing ACL injury rates on artificial turf and natural grass among National Football League (NFL), National Collegiate Athletic Association (NCAA) football, and professional soccer players were included. Exclusion criteria encompassed studies focused on non-ligamentous injuries, youth athletes, or surfaces outside of competitive play. Key data on injury incidence, risk ratios, and biomechanical factors were extracted and analyzed.
Results: Forty-two articles were initially identified, of which fifteen studies met the inclusion criteria, representing 7,800 athletes across football and soccer. Among NFL players, ACL sprains were 67% higher on FieldTurf than on natural grass (p \u3c .001), though overall ACL injury rates per team game showed no significant difference (p \u3e .05). NCAA Division II and III football players experienced 1.63 times higher ACL injury rates on turf compared to grass (p \u3c .05). In professional soccer, ACL injury rates were higher on natural grass (1.16 per 10,000 athlete exposures) than on artificial turf (0.92 per 10,000 AEs) (p \u3c .0001). However, female soccer players had an 18% higher ACL injury risk on artificial turf compared to natural grass (p = .004), whereas male players showed no significant difference. Biomechanical studies indicated that higher rotational forces and cleat-surface traction on artificial turf may increase ACL injury risk, particularly in football and female soccer players.
Conclusion: ACL injury risk on artificial turf varies by sport and athlete demographic. While NFL data remains inconclusive, NCAA football players and female soccer athletes show a higher ACL injury risk on artificial turf, whereas male soccer players experience no significant difference. Increased surface friction and cleat engagement may explain these findings. Further longitudinal studies are needed to refine injury prevention strategies for athletes competing on artificial surfaces
ADHD treatment in adults: Evaluating the efficacy of stimulant medication combined with cognitive behavioral therapy
No full textAttention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent neurodevelopmental disorder that presents with features of hyperactivity, inattention, and impulsivity which impair concentration and normal neurocognitive function. Stimulant medications, namely Methylphenidate, are the first line treatment for ADHD, however, it carries potential side effects including but not limited to: headaches, anxiety, mood changes, hypertension, and tachycardia (Weibel et al., 2021). In addition to stimulants, Cognitive Behavioral Therapy (CBT) has shown promising results when treating adults with ADHD. The article “A comparison of efficacy between cognitive behavioral therapy (CBT) and CBT combined with medication in adults with ADHD” revealed that CBT with or without adjuvant stimulants resulted in significant improvement compared to baseline symptoms, including anxiety and depression (Pan et al., 2019). Understanding the effectiveness of a combined treatment approach is critical for optimizing long-term outcomes in adults with ADHD.
This literature review aims to evaluate whether the combination of stimulant medication and CBT results in greater symptom improvement compared to stimulant treatment alone in adults with ADHD. A thorough search was done through the Philadelphia College of Osteopathic Medicine (PCOM) Online Library, following PICO criteria to identify relevant studies that provided data on both CBT and stimulants for ADHD. Preliminary findings suggest that psychological interventions such as CBT showed significant improvement in symptoms when combined with methylphenidate compared to placebo groups (Lam et al., 2024). Overall, the integration of CBT with stimulant medication appears to yield superior outcomes compared to medication alone, particularly in improving executive functioning and long-term adherence. These findings have important implications for primary care and psychiatric management, suggesting that a multimodal treatment approach should be prioritized for adults with ADHD
The impact of general anesthesia on postoperative respiratory complications in patients with chronic obstructive pulmonary disease (COPD): A literature review
Full text linkChronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease characterized by airway narrowing and alveoli breakdown that eventually causes air trapping leading to increased Total Lung Capacity (TLC) and compromised expiration. COPD includes chronic bronchitis and emphysema, which are common among smokers. Patients with COPD are at increased risk of perioperative complications, including but not limited to: Increased post-operative pulmonary complications (PPCs), increased risk of respiratory infections, respiratory failure, prolonged ventilator dependence, and subsequent increased length of hospital stay. Understanding the relationship between COPD severity and postoperative outcomes is critical for optimizing perioperative management and reducing morbidity and mortality in this patient population. This literature review evaluates the effects and perioperative risks associated with general anesthesia in COPD patients. Specifically, it examines the impact of COPD severity on postoperative outcomes and identifies key risk factors contributing to PPCs.
Thorough research was conducted through the PCOM online library to identify relevant peer-reviewed articles examining the relationship between COPD and general anesthesia. Studies were selected based on their relevance to perioperative risks, postoperative respiratory failure, and anesthetic considerations in COPD patients.
Preliminary evidence suggests that while COPD severity, as classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), is not directly correlated with postoperative respiratory failure, lower preoperative arterial oxygen pressure (PaO₂) is a significant predictor of respiratory complications (Hou et al., 2022).
Additionally, the study “Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study” showed that prolonged ventilation, higher ASA classification, and COPD and smoking history are important risk factors for PPCs. (Feng et al., 2024).
These findings highlight the importance of individualized perioperative strategies for COPD patients undergoing general anesthesia. Enhancing preoperative oxygenation, minimizing ventilatory pressures, and tailoring anesthetic techniques can reduce the incidence of PPCs. Future research should focus on refining perioperative management protocols to improve the post-operative course in COPD patients
Cadaveric Case Study of Renal Artery Variation
Full text linkIntroduction: The renal artery is a crucial blood vessel responsible for supplying oxygenated blood to the kidney. In typical anatomy, the renal artery branches off the abdominal aorta at the L1-L2 vertebral level, branching into the left and right renal arteries. This artery is especially crucial as the kidneys receive roughly 25% of cardiac output through the renal artery to filter waste from the blood and maintain homeostasis. Proper blood flow to the kidneys through the renal artery is also essential in monitoring blood pressure through the renin-angiotensin-aldosterone system.
Methods: This study involved a cadaveric dissection using standard anatomical techniques, with careful isolation of systemic organs and vascular structures. High-resolution photographic imaging documented renal vascular variations, with images analyzed for arterial branching patterns, and anatomical relationships to adjacent structures. The length of the arteries was measured using an onsite standard calibrated ruler, ensuring accurate dimension assessment. A comprehensive literature review of medical databases was conducted to compare observed findings with documented anatomical variations.
Results: A secondary renal artery was identified, originating from the abdominal aorta below the L1-L2 region. Both renal arteries directly supply the left kidney. The variation branched inferior to the primary renal artery and exhibited an atypical lateral division. It measured approximately 6.5 cm in length, whereas the primary renal artery measured 6.0 cm. Following the removal of the fibrous capsule, the left kidney’s cortex displayed an irregular surface texture, suggesting potential pathological associations such as hypertension or altered perfusion, though further investigation is required. Photographic documentation highlights this vascular variation and its anatomical relationship to the primary renal artery. Upon isolating both kidneys, the inferior renal polar artery was found to be unilateral, present only on the left side of this cadaver.
Discussion: The presence of a secondary left renal artery in this cadaver shows the surgical and clinical significance of renal vascular anomalies. While a single renal artery arising from the aorta at the level of L1-L2 is typical, secondary renal arteries may interfere with surgical and radiological procedures if undiagnosed. Additionally, the granular appearance of the renal cortex may suggest the effects that vascular anomalies may contribute to hypertension via the renin-angiotensin-aldosterone system and arterial stenosis. Further research is necessary to explore the frequency of these vascular variations and their physiological consequences, particularly in relation to hypertension. Understanding these anomalies could improve preoperative imaging protocols, enhance surgical outcomes, and inform clinical management strategies for patients with renal vascular disorders.
Conclusion: This case report describes an atypical variation of the left renal artery, with potential implications for future surgical management, diagnostic imaging, and clinical interventions. The observed anomaly highlights the importance of recognizing vascular variations for better understanding factors that affect normal blood flow rates within systemic organs and can compare it in individuals without these variations present. Further studies are needed to explore the prevalence and clinical significance of such variations in diverse populations
Robotic Assisted Repair of a Concomitant Paraesophageal and Left Diaphragmatic Hernia
Full text linkBackground: The vast majority of diaphragmatic hernias in adults are repaired using the laparoscopic approach. The robotic platform is increasingly accepted by foregut surgeons. The most common diaphragmatic hernias are hiatal hernia, but defects may also occur at other sites. Concomitant combined defects are extremely rare and require special techniques including placement of a mesh.
Case report: A 65 y/o female presented with a large symptomatic paraesophageal hernia – her body mass index was 35kg/m2. She complained of gastroesophageal reflux despite using a proton pump inhibitor, regurgitation, epigastric and back pain, shortness of breath, and nocturnal coughing spells. She was counseled regarding diet and weight loss and over the next 3 months she was able to drop 25 pounds, and her symptoms improved somewhat. She underwent robotic assisted paraesophageal hernia repair. During exploration, a sizable sliding hiatal hernia was found, however, the fundus was incarcerated within a 4cm defect just lateral to the left crus. The peritoneum at the hiatal hernia was incised and the hernia contents were reduced, the sack was resected. The esophagus was undermined and dissected free and good intraabdominal length was obtained. Next the contents of the 2nd hernia were gently reduced after the gastrocolic ligament was opened and the short gastric vessels were divided. As the cruroplasty pulled the left crus to the midline, primary repair was impossible, and this defect was closed with coated mesh. A standard floppy Nissen fundoplication was created, and a PEG tube was placed to anchor the stomach in the abdomen.
Results:
She had an uneventful early postoperative course and was discharged on day 2 after an upper GI series showed no leak or stenosis. She did well for a week but then inadvertently pulled the PEG tube out. She underwent exploratory laparoscopy, and the gastric defect was staple closed. Further clinical course was uneventful, and she was well without signs of recurrence after two years.
Discussion: We report successful management of the rare condition of a double diaphragmatic hernia. The second defect needs to be closed tension free with a mesh due to the tension at the repairs to avoid failure and hernia recurrence