The following abstracts and posters were winners in the 2017 AOMA Poster Forum. Posters were submitted in three categories: case , research, and performance/population improvement. They were judged separately and a winners chosen in each category.
Clinical Case Poster Winners
1st Place - Cervical Pregnancy: A Case Report and Review of the Literature of a Rare and Life-Threatening Obstetric Emergency - Aaron Rochester, OMS III; Alicia Cryer, OMS III; Farshad Agahi, MD; Deena Tajran, MD
Abstract: Cervical Ectopic pregnancy is a rare and life-threatening condition. Patients may present with painless or pain and vaginal bleeding. A misdiagnosis can lead to a potentially fatal hemorrhage; this case report aims to provide insight into a successful conservative management of cervical ectopic pregnancy.
2nd Place - Massive Hemorrhagic Pericardial Tamponade - James Layson, OMS III; William Peppo, DO, FACO, FCCP, FACP
Abstract: This is a case of the 65-year-old female with massive hemorrhagic pericardial tamponade secondary to pericardial metastasis of lung cancer. She was recently diagnosed with lung adenocarcinoma five months prior, and elected to travel to Arizona to explore alternative therapies. She presented with progressive two week shortness of breath, nonproductive cough, nausea, weakness, fatigue, lower extremity swelling, and an eight week 20-pound weight loss. The patient’s labs conveyed a picture of prerenal azotemia, warranting evaluation of cardiac output and function via echocardiography. The echocardiogram revealed collapse of the left ventricle, right ventricle, and right atrium secondary to a large pericardial effusion, resulting in tamponade. After the pericardial effusion was noted, the patient was evaluated by cardiology and physical exam revealed jugular venous distention, diminished heart sounds, pericardial rub, and lower extremity edema. An emergent pericardiocentesis was performed and 1000 mL of hemorrhagic fluid was removed from the pericardial sac. 200 mL of fluid was drained overnight, and catheter was removed the following morning. Over the following days, the patient’s heart function and dependent lab values improved.
3rd Place –Inferior Vena Cava Aneursym with Associated Bilateral Duplicated Renal Arteries: Case Study and Literature Review - Matthew Kay, OMS III; Taylor Kjar, OMS III; Mac Martin, OMS IV; Imtiaz Ahmed, MD; Charles Finch, DO, FACOEP
Abstract: IVC aneurysms are rare complications with fewer than 60 documented cases in the last 63 years. Though complete etiology of their formation is as yet unclear, most sources agree that there is an embryological component involved in the development of caval aneurysms. These components carry with them multiple other structural and organogenic defects. There have been however, scattered reports of non-hereditary mechanisms of IVC aneurysm formation, such as trauma and longstanding systemic venous hypertension. The present case is of a 57-year-old female with a history of hypercholesterolemia, who presented to the outpatient clinic complaining of three days of diffuse abdominal pain. Incidental findings of an abdominal CT showed a distal Type IV fusiform IVC aneurysm, measuring 35 x 25 x 54 mm, with comorbid bilateral aneurysmal dilation of the iliac veins. Additionally, elucidated from the CT of the abdomen was bilateral dual renal arterial supply, notedly end-arteries. Due to the absence of known etiologic factors or processes, such as trauma or inflammation, as well as the presentation of the aneurysm with bilateral dual renal arteries, this patient’s IVC aneurysm is supposed to be embryological in origin. The patient is currently undergoing additional studies to further investigate potential mechanisms and complications of her condition. Conservative or surgical treatment will then be determined.
1st Place – Grave’s Thyrotoxicosis and Guideline Implementation - Matthew Beeton, DO, OGME2; Marc Kaplan, DO; Jeffrey Wilde, MD
Graves’ thyrotoxicosis is a specific entity of hyperthyroidism in which antibodies inappropriately stimulate the thyroid gland to overproduce or secrete t3 and t4 hormones. This affects widespread cellular function and spurs hypermetabolic symptoms including tachycardia, fatigue, weight loss, etc. There are different ways of treating and managing this entity which should be customized to the patient. The following case illustrates Graves thyrotoxicosis and utilizes evidence-based guidelines that have been published by the ATA, AACE.
Research Poster Winners
1st Place (TIE)– Dietary Genistein (SOY) Increases Survival Rates, in the Absence of Laxative, in DF508-Cystic Fibrosis Mice - Charisma Mylavarapu, OMS II; Nathan Fairbourn, OMS: Ammer Dbeis, OMS II; Craig Hodges, PhD; Layla Al-Nakkash, PhD
Abstract: The most common clinically seen mutation in cystic fibrosis (CF) is DF508. The goal of this study was to determine whether dietary genistein reduces the dependence of the DF508 CF mouse on laxatives for survival, and thereby improves mortality rates. Genistein is a naturally occurring isoflavone found in soy. Mice homozygous for the DF508 mutation are characterized with severe intestinal disease and require constant laxative (Colyte) treatment for survival. This pathology mimics the intestinal obstruction (meconium ileus) seen in 6-20% of CF patients. At age 21 days, DF508 mice were maintained on one of three diets for 45 days post weaning; normal diet, normal diet + Colyte, or 600G (600 mg genistein/kg diet). Survival rates were as follows; males fed normal diet = 38% (8/21 mice), males fed normal diet + Colyte = 83% (35/42 mice), males fed 600G = 60% (9/15 mice) and females fed normal diet = 47% (9/19 mice), females fed normal diet + Colyte 71% (27/38 mice), females fed 600G = 87% (13/15 mice). At the end of the diet study, body weight was greater in males fed 600G (21.96±0.68 g, n=14) versus those on Colyte (18.86±0.64 g, n=8). Weight gain was comparable in the female groups. In order to better assess how dietary genistein supplementation improves survival and/or weight gain in DF508 mice, we examined the following. (1) histomorphometric analyses of jejunum, (2) western blot protein expression of key jejunum epithelial transporters (Glut2, Glut5, CFTR, Na+/K+-ATPase, NKCC1), and proteins involved in metabolism (11βHSD-1, GR). We predict that beneficial effects of genistein diet are likely mediated in part via upregulation of key metabolic pathways, and likely due to increased expression of key transporters involved in chloride secretion (CFTR, NKCC1). We conclude that feeding DF508 mice genistein diet; (1) abolished the dependence on laxatives for survival, (2) significantly increased the survival rate of all DF508 mice compared those fed standard diet, and (3) generated a sex-dependent greater effect in females on survival rate. These studies could have impact on clinical interventions, given that the median age of survival in CF females is less than that for males.
1st Place (TIE) –Where Are We Going and Who Are We Serving? An Analysis of Trends in Osteopathic Medical Graduates Practice Type and Location - Matthew Kunz, OMS I; Jesse Richards, DO, PGY1; Caleb Scheckel, DO, PGY1: Jessica Newman, DO; Charles Finch, DO, FACOEP
Abstract: The American Association of Medical College estimates a shortage of 90,000 physicians in the U.S. by 2025. Medically underserved populations will be placed most at risk. Osteopathic Medical training continues to grow, and according to the American Osteopathic Association there has been a 65% increase in Osteopathic physicians since 2006. In this study we seek to analyze the practice plans identified by Osteopathic medical school graduates from the past 8 years.
2nd Place – Optimized Decoy Recombinant CD47 for Effective Mitigation of Thrombospondin 1-induced Vascular Dysfunctions:
A Mechanistic Study - Jalicia Sturdivant, OMS I; Mingy Yao, PhD; Tamer Elbayoumi, PhD
Abstract: Substantial elevation of thrombospondin 1 (TSP1) has been consistently implicated in pathogenesis of a variety of fatal cardiovascular conditions including ischemia-reperfusion injury, pulmonary hypertension and coronary artery disease.
TSP1-initiated signal cascades through its cognate receptor CD47 (a ubiquitous membrane protein) have been correlated with cardiovascular dysfunction. There is only one monoclonal antibody to interfere with TSP1-CD47-associated network, and it is indicated for cancer therapy.
3rd Place – The Effect of Dermal Suture Material on Complication and Patient Satisfaction: Monocryl vs. Vicryl - Cassandra Beard, OMS IV; Carmen Traywick, MD
Abstract: Functional and cosmetic outcomes from dermatologic procedures are important to consider as patient expectations rise and new suture materials are developed. The purpose of the current study was to determine whether complication rates and patient satisfaction rates differ between monofilament and braided sutures. Four hundred thirty-three patient records were retrospectively reviewed for complication rates after closure of dermal excisions with monofilament or braided sutures; data were analyzed and controlled for confounding variables. Patient satisfaction was analyzed by a self-made questionnaire sent electronically, and mean differences between the monofilament and braided sutures were analyzed. Two hundred forty-two participants who underwent closure with monocryl sutures were invited to complete this survey. Fifty-two of these participants completed the survey, representing a 21.5% completion response rate in the monocryl group. Sixty-four survey invites were sent to participants who received vicryl sutures. Fourteen of these participants completed the survey, representing a 21.9% response rate. There were no significant differences in complication rates (P= 0.76) or patient satisfaction rates (P= 0.78) between monofilament sutures and braided sutures. Based on this data, there is are no statistically significant differences in complication rates and patient satisfaction rates between the use of monofilament or braided sutures. Therefore, surgeons may elect to choose the type of suture used in dermatologic procedures based on ease of handling and knot tying properties in lieu of complication rates or patient satisfaction rates.
1st Place – Establishment of a Clinic-Based Biorepository-Sarah Belden, DO, PGY3; Richard Averitte, MD; Chandana Uppalapati; Agnes Pascual; Kathryn Leyva; Elizabeth Hull; McKale Montgomery
Abstract: As the incidence of skin cancer continues to rise, it is expected that there will be a parallel demand for cutaneous tumor samples for biomedical research studies. We created a protocol to collect and process cutaneous tumor and associated adjacent normal tissue, blood, and saliva samples that has minimal impact on routine clinical procedures on the date of Mohs surgery. A clinic-based biorepository was established and the samples were validated in downstream applications using explant culture, RNA isolation, western blot analysis, cell cultures, and histological evaluation.
Performance/Population Improvement Poster Winner
1st Place - Distracted by Diabetes: An Evaluation of Cervical Cancer Screening in Diabetic Patients - Bradley Brown, OMS II; Jessica Bodden, MS II
Abstract: A retrospective study revealed breast, colorectal and cervical cancer screening gaps in patients with one or more chronic conditions. There is little research regarding the patient-centered medical home (PCMH), and the ability to screen diabetic patients for cervical cancer. This study aims to evaluate this gap and assess potential barriers.
2nd Place - Effect of Colorectal Cancer Education on Compliance of Fecal Occult Blood Testing Among El Rio Community Health Center Patients - Maryann Davies, OMS III; Jenni Adams, OMS III; Sofia Mani, OMS III; Mary Haywood, OMS III; Jessica Kao, OMS III; Esther Quintero, OMS III; Joe Shorall, OMS III; Zuma Speakman, OMS III; Kate Whelihan, MPH, CPH; Joy Lewis, DO, PhD, FACP
Abstract: Colorectal cancer (CRC) is a leading cause of cancer death with high screening noncompliance rates. The baseline El Rio Community Health Center (CHC) completion rate for CRC screening was 22.9% in the second quarter of 2015. This study’s objective was to evaluate effectiveness of patient education regarding CRC on fecal occult blood testing (FOBT) completion rates.
3rd Place - Evaluating the impact of the Nutrition and Health Awareness Program on Physical Activity and Health Awareness- Darien Kinne, OMS II; Adrienne Marler, OMS II; Brigham Bahr, OMS II; Grady Cook, OMS II; Carolina Espindola-Camacho, OMS II; Rudolf Estes, OMS II; Jamie Obler, OMS II; Jennifer Oster, OMS II; Abhishek Pandya, OMS II; Darrell Ray, OMS II; Bradley Meek, DO; Mark Sivakoff, MD; Joy Lewis, DO, PHD; Kate Whelihan, MPH, CPH
Abstract: Inactivity is a known risk factor for obesity and chronic diseases such as diabetes and hypertension. The CDC reports that only one third of children ages six to seventeen meet the recommended sixty minutes per day of physical activity. Exercise is not as effective at reducing or preventing obesity without proper nutrition. Increased understanding of these health concepts may improve children’s well-being and help them develop health-seeking behaviors for the future. The “Nutrition and Health Awareness” (NHA) program is a five week interactive curriculum, revised and conducted by second year medical students from A.T. Still University - School of Osteopathic Medicine in Arizona. It aims to teach children the basics of health and wellness, namely the importance of exercise, nutrition, portion control, food groups, and chronic diseases such as heart disease and diabetes. Initial activity levels and health awareness of 5th grade participants (n=25) are measured at week zero, followed by five weekly lessons regarding nutrition and health concepts. Physical activity is evaluated using SqordTM accelerometer activity trackers while health awareness is assessed using a questionnaire based on the NHA curriculum. Accelerometers are worn continuously for twelve weeks and allocate points according to an intensity-based algorithm. The assessment questionnaire is given at weeks zero, six, and twelve to assess attitudes toward and understanding of important health concepts. Data collection is underway.
Baseline activity levels and health knowledge were recorded, and the lecture series will be complete March 9th, 2017. Preliminary data analysis will be available by March 27th, 2017. An increase in physical activity and health knowledge is expected. Statistical significance of changes will be assessed with an ANOVA. Significant changes in activity and/or health awareness may suggest success of the NHA program among the chosen participants, allowing it to be applied in other communities. Studies that identify communities in need would improve the impact of the NHA program on other 5th grade participants.
1st Place – Improving Obstetric Hemorrhage Morbidity and Mortality by a Checklist Based Management Protocol -Rachael Smith, DO, PGY3; Michael Foley, MD; Laurie Erickson, MD; Laura Mercer, MD
Abstract:To improve maternal morbidity and mortality, screening, early diagnosis, and healthcare delivery for obstetric hemorrhage at Banner Health with the implementation of a checklist based management protocol for postpartum hemorrhage.
Postpartum hemorrhage remains a major cause of maternal morbidity and mortality in the United States. While existing guidelines outlining a general approach to postpartum hemorrhage are useful, recent data suggest that greater specificity is necessary to significantly impact morbidity and mortality.