Philadelphia College of Osteopathic Medicine
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Clinical trials in neurology registered 2007-2018 demonstrate room for improvement in reporting and representation of race and ethnicity.
Full text linkIntroduction: Clinical trials form the basis for advancing medical best practices, yet lack of diverse representation perpetuates healthcare disparities. We aimed to characterize trends in reporting and representation of race and ethnicity in neurology clinical trials.
Methods: In a cross-sectional study of United States (US) based trials (2007-2018) with results reported to the ClinicalTrials.gov registry, we assessed whether race/ethnicity data were reported and evaluated trial diversity by comparing race and ethnicity representation (proportion of enrolled participants reported as White, Black, Hispanic, Asian, or Native American) to 2010 US Census data. We studied the role of trial funding sponsor (Industry, US Government, Academic) and 19 neurologic disease foci: Malignancy, Neurovascular, Peripheral Nervous System/Spine, Movement, Trauma, Neurodegenerative, Pain, Headache, Malformation, Inflammation, Seizure, Sleep, Systemic Disorders, Muscle and Neuromuscular Junction, Infection, Cutaneous, Autonomic, Otology, Other. Results: Of 16,953 neurologic trials, 37.5% (6,361) were US-based of which 2,514 (39.5%) reported results to the registry. 1,444 (57.4%) reported any race/ethnicity data involving 151,263 participants. Reporting was significantly associated with sponsor (p\u3c 0.001) and disease category (p\u3c 0.001). Racial and ethnic minorities (17.6%) were underrepresented relative to US Census data (27.6%) most notably with Hispanic (6.2% vs 15.4%) and Asian (0.8% vs 5.0%) patients. Trials regarding Autonomic, Otology, Systemic, and Movement Disorders were least diverse (all \u3c 10%) while Infection (56.1%), Neurovascular (33.4%), and Trauma (32.4%) were most diverse.
Conclusions: We found that clinical trials in neurology inadequately report race/ethnicity data and when doing so are not representative of the US population, which perpetuates systemic healthcare inequalities. This presents an opportunity for the field to further investigate the barriers to trial enrollment and improve access in future efforts to reduce existing disparities
The Effectiveness of Early vs Delayed Medial Malleolar Fixation in the Treatment of Open Ankle Fractures
Full text linkIntroduction
Open ankle fractures are high-risk injuries with significant complications, including infection, wound dehiscence, and necrosis, often requiring multiple surgeries. This study evaluates early versus delayed fixation of clean, open medial malleolus fractures, hypothesizing no difference in infection rates between the two cohorts.
Methods
A retrospective chart review of 99 open ankle fractures involving the medial malleolus was conducted at a level 1 trauma center between November 2016 and July 2024. Fractures were divided into “Early” (immediate ORIF) and “Delayed” (ex-fix followed by ORIF) groups. Ankles were excluded if the fractures were closed, severely contaminated, polytrauma, and insufficient follow-up. Primary outcomes were infection rate, length of hospital stay, number of operations, and return to the operating room. Secondary variables include union rate, pain scores, time to weight bearing, antibiotic course, and wound care.
Results
Among 99 fractures, 55 underwent early fixation and 44 delayed fixation. Infection rates were 18% in the early group and 9% in the delayed group (p=0.19). Early fixation was associated with significantly shorter LOS (7.8 vs. 12.8 days; p=0.0004) and fewer operations (1.3 vs. 2.4; p\u3c 0.0001). Union rates (95% early vs. 91% delayed; p=0.69) and symptomatic nonunion rates (4% early vs. 5% delayed; p=0.99) were similar. Wound care initiation was higher in the early group (56% vs. 27%; p=0.0037), but other secondary outcomes, including time to weight-bearing and pain levels, showed no differences.
Conclusion
Early fixation of clean open ankle fractures reduces LOS and the number of operations without increasing infection or nonunion rates. The higher incidence of wound care in early fixation highlights the importance of careful patient selection and soft tissue management. These findings suggest early fixation is safe and may improve resource utilization for appropriately selected cases
Plaque-like CD34+ dermal fibroma on the toe: A case report and literature review
Full text linkPlaque-like CD34+ dermal fibroma (PDF), also referred to as medallion-like dermal dendrocyte hamartoma (MLDDH), is a rare, benign dermal neoplasm that typically presents as a slow-growing, asymptomatic plaque. PDF is most commonly seen on the neck or trunk of young women. The pathogenesis of PDF remains poorly understood. Histologically, these lesions are characterized by the proliferation of spindle-shaped fibroblasts in the dermis, which are strongly positive for CD34 and negative for markers such as S100, Melan-A, and Factor XIIIa.
We present a case of a 57-year-old female with a one-year history of a plaque-like CD34+ dermal fibroma on the dorsal surface of her left first toe. The lesion was asymptomatic but had been gradually increasing in size and changing color over several months, prompting clinical investigation. A tangential biopsy was performed. Histopathological analysis confirmed the diagnosis, revealing a neoplasm of wavy and spindle-shaped cells predominantly arranged in parallel fascicles that interweave within the upper reticular dermis. The immunohistochemical profile demonstrated strong positivity for CD34, with negative staining for S100, Melan-A, and Factor XIIIa, further supporting the diagnosis. Given that the lesion is unusual in this patient’s age group, complete removal was recommended. The lesion was successfully excised with clear margins, and the patient had a generally uncomplicated postoperative course. At the 10-day postoperative follow-up, mild redness and pain were noted, which resolved without signs of progressive infection. Gram stain and bacterial cultures were taken, both of which returned negative results. There was no recurrence of the lesion.
A comprehensive review of the literature identifies a limited number of reported cases of plaque-like CD34+ dermal fibromas, most of which are located on the neck or trunk, with few cases involving the proximal extremities. Notably, there have been no reports of these lesions occurring on the distal extremities. To our knowledge, this is the first documented case of a plaque-like CD34+ dermal fibroma occurring on the toe.
Phase transfer of Plasmonic Nanoparticles: A gateway to biomedical Innovations
Full text linkThe use of nanoparticles has emerged as a promising approach to overcoming clinical challenges faced by physicians and scientists striving to enhance drug bioavailability, improve diagnostics, and promote tissue regeneration. Among these, phase-transferred plasmonic nanoparticles—known for their highly tunable optical properties—have shown significant potential in various biomedical applications. These include surface functionalization for enhanced biocompatibility, antimicrobial treatments, advanced sensing and diagnostic tools, drug delivery systems, photothermal therapy, and imaging technologies.
This systematic review explores recent applications of phase-transferred plasmonic nanoparticles in improving therapeutic outcomes in human subjects. A comprehensive analysis of peer-reviewed studies from major literature databases was conducted, focusing on plasmonic metal nanoparticles (primarily Ag, Au, Pt, Pd, Cu, and their alloys) dispersed in organic solvents. The findings indicate that these nanoparticles contribute to positive clinical outcomes, such as improved anti-inflammatory responses, reduced oxidative stress, and enhanced patient-reported outcomes in chronic diseases. However, the review also highlights significant variability in nanoparticle formulations, underscoring the need for standardized methodologies to optimize their therapeutic potential
The impact of interactive food demonstration on nutrition education and dietary habits
No full textIntroduction: Around 60 percent of American adults have at least one chronic disease that could mostly be managed by nutrition. The Mediterranean diet has been linked to reducing the risk of numerous health conditions, including hypertension, coronary artery disease, and other cardiovascular diseases that have high prevalence in the city of Philadelphia. This diet is known for scaling back on salt and red meats along with having an increased focus on whole grains, fruits, vegetables, legumes, olive oil, and healthy fats. With its ability to provide satiety and variation based on individual palate preferences, Mediterranean cuisine has been shown to have high compliance and a positive impact on health outcomes. The importance of educating individuals on the value of holistic dietary habits is profound, as there are various studies that demonstrate how education increases the likelihood of patients incorporating proper nutrition in their daily lives.
Methods: This study featured interactive food demonstrations within clinical settings . Patients in the waiting room first completed a demographic survey, followed by a pre survey with eight nutrition related questions to assess their baseline knowledge and habits. During recipe sampling, a guided discussion of the patient’s responses, followed by a post-survey of the same eight questions to evaluate knowledge retention. The patient received ingredient take-home bags to encourage at-home replication. Follow-up surveys at one and three months assess retention of nutritional knowledge and any dietary behavior changes.
Results: There was a statistically significant improvement in test scores following the food demonstration, with the mean test scores increasing from 47.03% to 88.14% (p\u3c 0.001). At the one-month follow-up, participants reported that the food demonstration impacted their food choices, averaging a score of 3.88 on a 5-point scale, where 5 indicates a significant impact. Participants reported they ate home-cooked meals more frequently (p=0.013) and ate whole grains more frequently (p=0.021) at the one-month follow-up compared to baseline. Additionally, a moderate correlation was observed between participants who initially expressed a likelihood of making the recipes and those who actually prepared them at the one-month follow-up (ρ=0.544, p=0.007).
Discussion: Interactive food demonstrations serve as an effective and engaging tool for enhancing nutrition education and influencing dietary choices, suggesting their potential role in reducing chronic disease prevalence in the Philadelphia community. Participants showed significant improvements in nutrition knowledge and reported increased home-cooked meal frequency. However, a larger sample size is necessary to assess demographic differences. Limitations include the short follow-up time, limited access to healthy ingredients, and reliance on self-reported data. Further research with extended follow-up is necessary to evaluate the sustainability of diet changes and the potential long-term impact on blood pressure. Integrating these demonstrations into community health programs could enhance their impact and reach
Enhancing Curcumin Bioavailability: A Systematic Review of Nanoparticle-Based Approaches
Full text linkCurcumin, a bioactive compound derived from turmeric (Curcuma longa), is widely recognized for its potential therapeutic properties, including anti-inflammatory, antioxidant, and anticancer effects. However, its clinical application is hindered by poor bioavailability, primarily due to low solubility, rapid metabolism, and poor systemic distribution. Nanoparticle-based delivery systems have emerged as a promising approach to overcome these challenges, offering enhanced stability, targeted delivery, and controlled release of curcumin.
This review evaluates the efficacy of nanoparticle-based curcumin delivery systems in improving bioavailability and therapeutic outcomes in human subjects. A systematic review of peer-reviewed studies from major literature databases was conducted. Inclusion criteria included the use of nanoparticles such as liposomes, polymeric nanoparticles, and solid lipid nanoparticles, among others. Outcomes assessed included curcumin plasma concentration, therapeutic efficacy, and safety profiles.
The results indicate an increase in curcumin bioavailability with nanoparticle-based formulations compared to conventional formulations. Several studies reported enhanced therapeutic outcomes, including improved anti-inflammatory markers, reduced oxidative stress, and better patient-reported outcomes in chronic diseases. The analysis also highlights variability in nanoparticle formulations, emphasizing the need for standardized methodologies to optimize delivery systems
Enhancing Academic Success and Efficiency (E.A.S.E.) Program at PCOM South Georgia
Full text linkINTRODUCTION: First-year medical students face many challenges as they begin their educational journey. Programs like the E.A.S.E. (Enhancing Academic Success and Efficiency) program aims to address these challenges by fostering academic confidence, peer support, and improved comprehension of didactic material. Through peer-led support sessions and academic workshops, the program helps students build a solid foundation for success. Peer teaching, a core component of such initiatives, offers additional benefits, enhancing learning for both the teacher and the learner. It fosters a collaborative environment where students can share experiences and provide mutual support, ultimately improving academic performance and engagement.
OBJECTIVES: The primary objectives of the E.A.S.E. program is to assess its impact on first-year students\u27 academic performance and resilience, as well as the support provided by fourth-year students. It also explores how participation enhances fourth-year students\u27 teaching skills, confidence, and leadership. Secondary objectives include identifying challenges and successes in peer teaching and examining changes in first-year students\u27 perceptions of peer support.
METHODS: The study population will include first- and fourth-year medical students enrolled at PCOM. First-year (M1) participants will be invited to participate via email. Eligible students must be incoming M1 students on any of the three campuses with no history of a leave of absence. Fourth-year (M4) students will be recruited directly by the Principal Investigator. These students must be in academic good standing and not currently in their first, second, or third year of training.
RESULTS: The study will collect quantitative data through pre- and post-surveys and exam scores, measuring academic confidence, peer support, and knowledge gains. Qualitative data from open-ended survey responses will provide insights into participants’ experiences. Experimental groups will start the E.A.S.E. program in either the first or second semester, while a control group receives standard resources. Data will be analyzed using statistical tests and thematic analysis to evaluate the program’s impact.
CONCLUSION: By providing structured peer mentorship, we expect to see improved study habits, lower anxiety levels, and greater confidence in academic performance among participants. We also anticipate that involving fourth-year medical students as mentors will not only help the first-years but will also enhance the leadership and teaching skills of the mentors themselves
Use of Simulation for Teaching Biomedical Sciences to Undergraduate Medical Students- A Scoping Review
Full text linkObjective: The objective of this scoping review is to understand the extent and type of evidence in relation to the use of simulation or SIM-based medical education pedagogies to teach biomedical sciences to undergraduate medical students in accredited medical schools, globally. The review considers literature published between 2014-2024.
Introduction: Simulation, which could be generally described as a computer-based or structured model and practice that replicates the processes, behavior, or characteristics of a real-world system or phenomenon, especially for the purpose of education or training, is increasingly becoming popular and relevant in medical education. However, discrete publications with relatively diverse experiences and outcomes require a critical appraisal and synthesis of evidence towards informing best practices and policies.
Inclusion criteria: The review only considered reports about populations of students enrolled in accredited undergraduate medical education programs that train medical doctors including DO/MD/MBBS/MBChB or equivalents in any country. Simulation, as a concept is considered as reportedly used in the context of teaching knowledge, skills or practice-related attitudes in biomedical science disciplines. Articles published in English Language were considered.
Methods: An initial search of the Cochrane and JBI’s Evidence-based Practice databases in October 2023 found no similar review. For this review, the primary databases searched included PubMed, ERIC, and Google Scholar. Only articles published in English between 2014-2024 were considered. The JBI SUMARI was the platform for screening, approval, extraction, synthesis and review. For screening and appraisal, two or more members of the review team were required to approve an article.
Results: A total of 20 articles were considered for this review out of the initial yield of 2,671. These included: 4 Analytical Cross-Sectional Studies- 2 from Australia, 1 from the USA and 1 from China; 3 Systematic Review and Research Syntheses; 3 Randomized Controlled Trials- 1 from China and 2 from Italy; 6 Quasi-Experimental Studies- 1 from Taiwan, 1 from the Netherlands, 1 from the both China and United Kingdom, 1 from Sweden, 1 from Indonesia and 1 from the United States; and 4 Text and Opinion Studies. Findings highlight the growing use of simulation and technology-enhanced learning in medical education, improving competency, retention, and engagement. Simulation, in its various fidelities and modalities including those aided by VR, AR, and PBL enhance motivation and skills but cannot fully replace hands-on training. Limitations include inconsistent assessment impacts, cost challenges, and accessibility concerns.
Conclusion: Simulation and technology-enhanced learning improve engagement, skills, and retention in medical education. Integration with traditional pedagogies or methods maximizes effectiveness. Virtual simulations aided by technologies, VR or AR offer immersive experiences but require careful implementation. Further research is needed to optimize training, address costs, and enhance curriculum integration
Anatomical Variations of the Anterior Cruciate Ligament: A Cadaveric Study on Sex and Age Differences
No full textIntroduction
The anterior cruciate ligament (ACL) plays a critical role in knee stability, particularly in controlling anterior translation and rotational movement of the tibia relative to the femur. Numerous studies have reported morphological differences in the ACL based on sex and age, which have implications for injury susceptibility, surgical reconstruction, and rehabilitation protocols. This study aims to investigate the anatomical variations of the ACL across different sexes and age groups, particularly within specific regions like South Georgia, contributing to a better understanding of its structural adaptations and clinical significance.
Objective
The primary objective of this study is to document and analyze variations in the ACL’s morphology based on sex and age. By conducting detailed dissections and comparative analyses, this research seeks to enhance current anatomical knowledge and underscore the clinical ramifications of these variations. A review of existing literature, combined with our findings, will provide a bridge between anatomical structure and practical clinical applications in orthopedics and sports medicine. This study will aid in refining surgical approaches, rehabilitation strategies, and preventive measures for ACL injuries.
Methods
This cadaveric study involves systematic dissection of knee joints to examine the ACL in terms of length, width, fiber orientation, and overall structural integrity. Photographic documentation will complement morphological observations. Specimens will be categorized based on sex and age group to assess anatomical differences. Additionally, a literature review will be conducted to compare our findings with documented variations and their clinical relevance. A comparative analysis will highlight significant trends and potential implications in orthopedic practice.
Results
Preliminary observations indicate that the ACL exhibits notable differences in morphology between males and females, as well as across different age groups. Factors such as ligament thickness, fiber density, and insertional footprint size vary and may contribute to differences in ACL injury risk and response to surgical interventions. These findings provide valuable insights into sex-specific and age-related anatomical differences, which can inform clinical practices such as ACL reconstruction techniques, rehabilitation protocols, and injury prevention strategies.
Conclusion
This study emphasizes the importance of recognizing anatomical variations in the ACL related to sex and age. A deeper understanding of these differences will contribute to improved diagnostic accuracy, surgical precision, and overall patient outcomes in orthopedic and sports medicine. By expanding the body of anatomical knowledge available to clinicians, this research enhances the appreciation of human variability and its implications in clinical practice
Histopathological changes at thoracic duct bifurcations: implications for lymphatic obstruction, fibrosis, and chylothorax risk
Full text linkIntroduction:
The thoracic duct (TD) is the primary lymphatic vessel responsible for transporting lymph into the venous system. Anatomical variants, including duplication, right-sided termination, and bifurcation, have been documented, though their clinical significance is not fully understood. Notably, studies indicate that the thoracic duct exhibits variant anatomy in approximately 40% of individuals, with multiple channels or partial duplications occurring in about 20% of cases. Bifurcation sites may experience unique structural and histopathological changes that contribute to dysfunction. However, little is known about how these sites may predispose individuals to lymphatic obstruction, fibrosis, and chylothorax.
Objective:
This study examines the variation in endothelial integrity of the thoracic duct (TD) by focusing on hematoxylin and eosin (HE) and trichrome staining to assess structural changes, including collagen dispersion, at branching sites. Specifically, we investigate whether endothelial integrity is compromised at bifurcation points, with attention to disruptions in endothelial continuity and alterations in collagen deposition. By comparing bifurcated and non-bifurcated TDs, we aim to identify any differences in the structural organization and integrity of the lymphatic endothelium.
Methods:
Cadaveric thoracic duct (TD) specimens were collected from post-mortem dissection, with one sample taken from the area containing multiple small branches and another from the non-branching portion serving as the control. Samples will be processed for H&E staining to evaluate cellular integrity, inflammation, and lymphatic dilation. Trichrome staining will assess collagen deposition and fibrosis at bifurcation points compared to non-bifurcated regions. Quantitative analysis of duct wall thickness, inflammatory cell infiltration, and fibrosis grading will be conducted.
Results:
We anticipate that samples with thoracic duct bifurcations will exhibit increased fibrosis, smooth muscle hypertrophy, and inflammatory infiltration, predisposing them to lymphatic dysfunction. Furthermore, structural abnormalities at these sites may correlate with a higher risk of chylothorax formation and lymphatic obstruction.
Discussion:
Findings from this study will provide novel insights into the structural vulnerabilities of the thoracic duct and their potential role in lymphatic pathology. This could improve diagnostic approaches, therapeutic interventions, and surgical management of lymphatic disorders such as chylothorax and lymphedema. These findings warrant further investigation into the clinical implications of TD bifurcations and whether they result from a failure in embryological remodeling rather than representing a benign anatomical variation