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  Trends in Thoracic Endovascular Aortic Repair in Patients 45 Years Old and Younger

  Brandon Diaz, Alexander Chen, Graham W. Long, Rose Callahan, Diane Studzinski, and Otto W. Brown

  Publication Date: 3-2024

  Objective:Thoracic endovascular aortic repair (TEVAR) is now the preferred method of repair for most aortic pathology. This report explores the indications, morbidity, and long-term implications of TEVAR in patients under 45 years old.
  Methods:This is a retrospective, single-institution study of electronic medical records for all patients under age 45 years treated with TEVAR from July 2006 to December 2022. Data collected included demographics, comorbidities, and 30-day and long term outcomes, including medical and aortic-related complications.
  Results:The study cohort consisted of 30 patients, mean age 32 years, 22 males (73.3%), 10 (33.3%) with hypertension, and 15 (50%) were smokers. There were 16 (53.3%) traumatic disruptions, 1 (3.3%) aneurysm, 1 (3.3%) penetrating atherosclerotic ulcer, and 12 (40%) dissections (7 Type A and 5 Type B). Three patients died within 30 days of their procedure for a perioperative mortality rate of 10%; the interval from procedure to death was a mean 4.3 days (SD ± 3.8). Twenty-one had at least 1 follow-up visit post-TEVAR and 22 underwent at least one follow-up imaging study. Thirty-day morbidity overall was 50% and included endoleak in 6 (20%), cardiac complications in 5 (16.7%), renal failure in 7 (23.3%), spinal cord ischemia in 1 (3.3%), graft failure in 1 (3.3%), limb ischemia in 3 (10%), and multi-system organ failure in 3 (10%). Of the 22 patients with follow-up imaging, endovascular reinterventions were required in 4 (18.2%), while open surgical reintervention was necessary in 1 (4.5%). Reinterventions occurred at a median of 3.7 months postoperatively (0.7-60.8) and were indicated for 1 expanding aneurysm, 3 endoleaks, and 1 for combined endoleak and expanding aneurysm. There was one late death at 1.1 months (aortic-related) and another deceased patient whose cause and date of death are unknown.
  Conclusion: Historically, patients that undergo TEVAR for underlying aortic pathologies, especially young patients, are followed long-term to monitor for further aortic degeneration and possible reintervention. In our study, majority of all reinterventions (80%) occurred within 1 year. However, all patients with traumatic aortic disruption who underwent TEVAR did not require any reintervention upon follow-up imaging. These patients may not require surveillance past one year

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  Utility of Great Saphenous Vein Mapping in the Detection of Superficial Vein Thrombosis Prior to Infrainguinal Arterial Bypass

  Melissa C. Hetrick, Ashley E. Beale, Graham W. Long, Sarvar Oreizi-Esfahani, Rose E. Callahan, Diane M. Studzinski, and Otto W. Brown

  Publication Date: 3-2024

  OBJECTIVE: The great saphenous vein (GSV) is widely used as a bypass conduit for the treatment of infrainguinal peripheral arterial disease. Preoperative vein mapping assesses both the quality and diameter of the GSV. Ultrasound findings regarded as unfavorable are the presence of superficial vein thrombosis (SVT), ipsilateral deep vein thrombosis (DVT), and small vessel diameter. Identifying a suitable conduit is of utmost importance as GSV bypasses have improved patency compared to alternative conduits. The primary objective of this study was to identify the percentage of patients with ipsilateral SVT as well as patient characteristics associated with SVT and unsuitable GSV.
  METHODS: Retrospective, single-institution study from March 2013-December 2021. All patients with peripheral arterial disease who underwent outpatient vein mapping were included. Unsuitable GSV was defined by the presence of SVT, DVT, or size < 2.5 mm in any segment (from proximal thigh to distal calf).
  RESULTS: A total of 191 patients met inclusion criteria. Most patients were male (71.7%), Caucasian (69.8%), and the mean(SD) age was 68.6(10.8) years. Ipsilateral SVT was identified in 10.5% of patients. No significant differences in demographics or comorbidities were identified in patients with and without ipsilateral SVT. Less than half (45.8%) of patients had GSV that was greater than 2.5 mm throughout, and only one third (37.4%) had a GSV conduit of adequate size without SVT or ipsilateral DVT. GSV conduits of adequate size and without SVT or ipsilateral DVT were associated with male gender, 86.6% male vs 13.4% female (p=0.001, OR 3.6 (95% CI 1.6-8.2)). After completion of vein mapping, 90 (62.1%) patients underwent infrainguinal bypass and the ipsilateral GSV was used as a conduit in 58.9% of cases.
  CONCLUSIONS: Our study revealed that 10.5% of patients have SVT identified on preoperative vein mapping. Given these findings, routine preoperative venous duplex should be performed to assess for the presence of SVT, as this finding is difficult to identify intraoperatively and may predict lower patency rates. Veins identified as unsuitable, based on size criteria alone, should still be investigated intraoperatively with ultrasound or direct surgical exploration as vessel diameter, unlike SVT, is a dynamic finding.

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  Iatrogenic nerve injuries during surgeries of the neck: a systematic review

  Tajuldeen Al-Hasani, Jickssa Gemechu, and Varna Taranikanti

  Publication Date: 5-2023

  Iatrogenic nerve injuries in the neck can present with a wide spectrum of symptoms ranging from mild pain, numbness, or weakness, to devastating consequences for patients such as permanent irreversible damage, disability, or even death. Surgical interventions in the neck region, especially those requiring radical dissections in the neck carry a significant risk of iatrogenic injury to several vital nerves passing through the neck such as vagus, phrenic, brachial plexus, cervical plexus, and ansa cervicalis.

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  Beyond COVID-19: The Impact of Recent Pandemics on Medical Students and their Education: A Scoping Review

  Moneb Bughrara, Stephanie Swanberg, Victoria Lucia, Keaton Schmitz, Dawn Jung, and Tracy Wunderlich-Barillas

  Publication Date: 5-2023

  Over the past two years, COVID-19 has greatly altered undergraduate medical education (UME) as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality UME. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared UME for COVID-19? This scoping review investigated the educational and personal impact of recent pandemics on UME and medical students.

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  Telemedicine Success - A Rapid Review

  Anna Carman and Victoria Lucia

  Publication Date: 5-2023

  Telemedicine involves utilizing telecommunications and technology to deliver healthcare - including diagnosis, consultation, education, care management, and patient self-management - to populations with otherwise limited access to care. It offers a broad-range of benefits, including increased care accessibility, improved continuity of care, and decreased costs, without sacrificing patient satisfaction. However, telemedicine requires unique skills and approaches, unfamiliar to many physicians. We conducted a rapid review of research-validated techniques, across multiple subspecialties, to identify research-validated techniques for maximizing telemedicine appointments, synthesized in a comprehensive list, in order to support clinicians in modern healthcare settings.

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  Analysis of the Efficacy of the Modified Finnegan Scoring System

  Benjamin Collaer and Victoria Lucia

  Publication Date: 5-2023

  Neonatal Abstinence Syndrome (NAS) is a constellation of opiate withdrawal symptoms including irritability, inadequate feeding/ growth, and seizures in neonates This condition occurs shortly after birth if the fetus had significant exposure to opiates in-utero. Since 2014, each NAS case at Beaumont Royal Oak and Troy Hospitals has had their treatment dictated by their score on the Modified Finnegan Scoring System (MFSS). This scoring system was created to minimize unnecessary opiate-based treatments for neonates with NAS. The main objective of this study is to analyze the efficacy of the MFSS and observe the change in patient outcomes since its implementation in 2014.

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  Chief Complaint and Geriatric Depression: Assessing Risk for 30- and 90-Day Readmission

  Eric James, Michelle Moccia, and Victoria Lucia

  Publication Date: 5-2023

  Readmission to the hospital has significant monetary costs and represents a care gap for older adults. This investigation examines how a positive geriatric depression screen and chief complaint contribute to 30- and 90-day readmission risk. Depression recognition with follow-up care is a critical first step to prevent adverse outcomes such as readmission.

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  Incidence of Myopathy in Post COVID-19 Patients undergoing Statin Therapy

  Jithin John, Eduardo Leon, and Ramin Homayouni

  Publication Date: 5-2023

  Statin-associated myositis has been documented since its first use, causing an increase in Creatinine Kinase levels. While some suggest avoiding statins in individuals with COVID-19, recent literature suggests that statin use is protective against SARS-CoV-2 infection due to its antioxidant and anti-inflammatory properties. The role of statin therapy in COVID-19 cases, especially regarding myopathy, remains scarce. We hypothesize that different statin therapies prior to SARS-CoV-2 infection are associated with an increased risk of myopathy and an increase in blood CK levels.

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  A retrospective study on the incidence of CKD Diagnosis Post COVID-19 infection with variations in glycemic control

  Eduardo Leon, Jithin John, Nick Ludka, and Ramin Homayouni

  Publication Date: 5-2023

  The COVID-19 pandemic has emphasized that the virus can cause multi-organ complications, especially in patients with pre-existing conditions such as type-2 diabetes mellitus (T2DM), who are at higher risk for poor outcomes. Some patients may also develop T2DM post-infection due to the virus's effects on insulin secretion and blood glucose regulation. Glycated hemoglobin (HbA1c) is a useful tool for assessing blood glucose levels over time, diagnosing diabetes and monitoring disease management. Elevated levels of HbA1c have been linked to diabetic nephropathy (DN) and chronic kidney disease (CKD), both of which are potential complications of COVID-19 infection. This study aims to investigate the development of CKD in patients with varying HbA1c levels, and other comorbidities after SARS-CoV-2 infection, hypothesizing that COVID-19 may accelerate the development of CKD in at-risk patients with higher levels of HbA1c.

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  Effectiveness of a Modified Difficult Colonoscopy Score A Retrospective Review of General Surgeon Performed Colonoscopies at a Community Hospital

  Killian Llewellyn, Lianne Caceres, Karen Childers, and John Parmely

  Publication Date: 5-4-2023

  Colonoscopy remains the mainstay of screening for colon cancer in the US and an essential operating room skill for general surgeons.

  ▪ A quality review was performed of general surgeons at a community hospital.

  ▪ Difficult Colonoscopy Score (DCS) was a score created to predict difficulty of colonoscopy which was defined as prolonged intubation time, need for external compression, or increased pain score [1]. We tested the utility in our community and resident-involved endoscopy department.

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  Phenotype characterization of genetic murine mouse models of developmental dysplasia of the hip (DDH)

  Stephanie Mrowczynski, Kevin Baker, and Michael Newton

  Publication Date: 5-2023

  Developmental dysplasia of the hip (DDH) is a congenital hip alteration that changes the “ball in socket” movement of the leg inside the pelvis. Genome-wide association studies have identified CX3CR1 polymorphisms associated with increased risk of Developmental Dysplasia of the Hip. Mouse models of CX3CR1 knock-out (KO) mice show unilateral, bony discrepancies between the femur head and acetabulum in comparison to wild-type (WT) mice, as well as gait impairment similar to that of humans with osteoarthritis (which develops in DDH patients later in life). The primary goal of this project is to assess joint congruity in a CX3CR1 KO model of unilateral developmental dysplasia of the hip and control populations via microcomputed tomography. The secondary goal is to evaluate bone and joint characteristics in CX3CR1 KO model of unilateral developmental dysplasia of the hip and control populations via microcomputed

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  Traumatic Thoracostomy Tube Management at a Community Hospital A Retrospective Review

  Christian Przeslawski, Peter Habib, Kita Mack, Vimal Love, Julie George, and Amelia Pasley

  Publication Date: 5-4-2023

  Thoracostomy tubes or chest tubes (CT) have been a mainstay in thoracic trauma treatment since the Vietnam war with their roots dating back to the 5th century [1]. Trauma is the number one cause of death in the world, with chest trauma being the second highest cause of trauma related death [2]. 18% of patients with a blunt thoracic injury require chest tube. Management varies widely and there is no general consensus on management [3].

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  A comparative study of medication profiles from AD, MCI and non-demented patients

  Md Golam Sharoar, Bhavya Koganti, Vaibhavkumar Falki, Zakia Zaman, Tammy Osentoski, and Stewart F. Graham

  Publication Date: 12-2023

  Background: The ever-increasing incidence of Alzheimer’s disease (AD) and the lack of effective therapeutics to treat the disease are leading to a “silver tsunami”. Current FDA-approved drugs to treat the disease are limited as their benefit is simply momentary relief of the symptoms. Due to the chronic and progressive nature of AD, patients are routinely prescribed multiple non-AD medications to preserve their ability to perform daily activities and to improve their quality of life. However, how those medications affect AD pathology remains unknown. In the present study, we have compared medication profiles of AD (n = 135), mild cognitive declined (MCI; n = 120), and non-demented (n = 259) patients, with an aim to determine the effects of top-ranked drugs on AD pathology.

  Methods: Study subjects (≥65 years) were recruited from an academic geriatric practice that is heavily focused on memory disorders. All subjects underwent for the following cognitive assessments: a) Clinical dementia rating scale (CDR), b) MiniMental Status Examination (MMSE), c) logical memory test, d) digit span forward and backward, e) category fluency test, f) ordering test, g) trails A&B, and finally the Geriatric Depression Scale. Individual medication for each subject was listed and they were categorized into major drug classes. Statistical analysis was performed to determine the frequency of each drug in each class.

  Results: Eight top-ranked drug classes were categorized from a list of 453 individual medications. Vitamins (30-40%) and anti-inflammatory (∼30%) drugs were the major categories for each cohort. Interestingly, 11% of drugs were proton pump inhibitors in non-demented patients, and this decreased by 8% in MCI, and 5% in AD. We found a reduced (8%) Lipitor prescriptions for AD patients compared MCI (11%) and non-demented (13%) patients. We are investigating the effects of these highly prescribed drugs on β-amyloid production/aggregation, cytotoxicity, plaque load, and tau phosphorylation in vitro and in vivo using cell culture and AD mouse models. Conclusion: While the effects of routinely prescribed drugs on AD pathology are not well known, we found reduced vitamins, proton pump inhibitors, and Lipitor in the medication profiles of AD patients compared to the non-AD population.

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  Relationship Between Obesity and Triple-Negative Breast Cancer: A Retrospective Study

  Mariam Aoun, Anna Jahshan, Nayana Dekhne, and Varna Taranikanti

  Publication Date: 5-2-2022

  INTRODUCTION
  Several research studies have identified a positive correlation between obesity and specific receptor statuses in breast cancer, including ER-positive, PR-positive, and HER2-positive breast cancers. However, triple-negative breast cancer (TNBC) in particular has not been studied in relation to body mass index (BMI), which suggests that an analysis of triple-negative breast cancer and its relation to obesity is warranted. This study aims to analyze the association between triple-negative breast cancer and BMI through a retrospective analysis in order to further guide patient counseling about TNBC risk factors.

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  Comparing Radiological characteristics of Neck Pain in Younger versus Older Patients: A retrospective analysis

  Jnana Aditya Challa, Abdul Majid Khan, and Varna Taranikanti

  Publication Date: 5-2-2022

  INTRODUCTION
  Neck pain commonly occurs during the fifth or sixth decade of life due to degenerative changes in the spine. With increased usage of digital technology from a very young age we hypothesized an earlier age of onset of these degenerative changes. There have been no recent epidemiologic studies that investigated difference in radiological changes seen in older versus younger patients presenting with neck pain. Hence, this study is undertaken to analyze the variability in radiological changes seen in the cervical vertebrae between older (>50) versus younger (≤50) patients presenting with the chief complaint of neck pain.

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  ERAS vs Non-ERAS: A Hospital Performance Metrics Comparsion in Patients Undergoing Spinal Fusion

  Richard W. Easton, Gregory Smith, Matthew Lipphardt, Nai-Wei Chen, Pestano Cecile, Hermeli Mateo, Austin Ahlgren, Brady Vibert, Andrew Sagante, and Susan Vander Beek

  Publication Date: 5-2022

  Hospital metrics are measures used to evaluate surgical quality. The goal is to improve standards of care (SOC). Hospital performance is made publicly available and has reimbursement ramifications.

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  Prospective Qualitative Analysis of Minimally Invasive Repair of Pectus Excavatum

  Timothy Elton, Diane Studzinski, Robert S. Morden, and Pavan Brahmamdam

  Publication Date: 5-2-2022

  INTRODUCTION
  Pectus Excavatum is the most common chest wall deformity and is frequently corrected with the Nuss procedure. Although this procedure has existed for several decades, new strategies are being adapted to reduce complications and improve efficiency. The aim of this study is to perform a qualitative review of the patient experience after minimally invasive repair of Pectus Excavatum.

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  Prehospital Use of Ketamine in the Pediatric Population

  Ashima Goyal, Revelle Gappy, Remle Crowe, John Frawley, Nai-Wei Chen, and Robert Swor

  Publication Date: 1-2022

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  Effect of SARS-COV2 on Adolescent PHQ-9 Screening Result

  Anisah Hashmi, Aimee Pollak, Leah Ludwig, Kerry P. Mychaliska, Mara Rubenstein, Olufunke Adeyemo, Stacey Shubeck, Liu Qu, and Mary Coffey

  Publication Date: 5-2-2022

  INTRODUCTION
  The SARS-COV2 pandemic created numerous stressors for adolescents including financial insecurities, family illness or death, home schooling, discontinuation of group activities, and decreased peer interaction. Prior studies have shown an increased risk for self-reported depression symptoms in pediatric patients following traumatic events. The purpose of this study is to compare rates of newly diagnosed depression in adolescents and self-reported depression symptoms prior to and during the pandemic.

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  Relationship Between Smoking and Triple-Negative Breast Cancer: A Retrospective Analysis

  Anna Jahshan, Mariam Aoun, Nayana Dekhne, and Varna Taranikanti

  Publication Date: 5-2-2022

  INTRODUCTION
  Breast cancer is currently the most common cancer by incidence among women in the United States with high mortality. Compared to other specific types, triple-negative breast cancer (TNBC) is considered to be an aggressive cancer with poor prognosis. Hence, it is important to study the risk factors associated with it. Smoking has been implicated in many cancers, including breast cancer. However, there is no evidence in literature that has shown a relationship between smoking and a specific type of breast cancer. The goal of this study is to analyze the relationship between smoking and TNBC so that we may improve the understanding of the risk factors related to this type of breast cancer.

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  Clearance of the Cervical Spine in Obtunded Pediatric Blunt Trauma Patients: Quality Assessment of an Existing Clearance Pathway

  Rachel Kalthoff, Elizabeth Boudiab, Diane Studzinski, Nathan Novotny, Pavan Brahmamdam, and Begum Akay

  Publication Date: 5-2-2022

  INTRODUCTION
  Obtunded patients following blunt trauma need clearance of the cervical spine (c-spine) that cannot depend on a clinical exam. Our center’s current pediatric c-spine evaluation pathway includes both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). The objective of this study was to review our use of both CT and MRI for obtunded pediatric trauma patients to assess the quality of our pathway and utility of MRI.

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  Perioperative Antibiotic Use in Neonatal Surgery

  Lior Kopel, Patrick Karabon, Nathan Novotny, Begum Akay, and Pavan Brahmamdam

  Publication Date: 5-2-2022

  INTRODUCTION
  The ideal duration of perioperative antibiotic prophylaxis to prevent surgical site infection (SSI) in neonates is undetermined. The aim of this study is to evaluate the association between the duration of perioperative antibiotics and SSIs in the neonatal surgical population.

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  Radioactive iodine therapy (RAIT) in N1 papillary thyroid cancer: Are we overtreating?

  Elizabeth Odil, Jordan Reilly, Fionna Sun, Diane Studzinski, Rose E. Callahan, and Sapna Nagar

  Publication Date: 4-28-2022

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  Functional Lung Segmentation from Computed Tomography Images using Deep Learning

  Duyen M. Quach, Evan Porter, and Thomas M. Guerrero

  Publication Date: 5-2-2022

  INTRODUCTION
  Functional avoidance treatment planning allows radiation oncologists to intentionally minimize radiation dose to higher-functioning lung areas while favoring radiation dose towards lower-functioning regions. This treatment planning method has been shown to reduce pulmonary toxicity for patients receiving radiation therapy. Functional lung information, traditionally ventilation or perfusion SPECT scans, is required to plan for functional avoidance.

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  Acute Post-Operative Pain Following Anterior Cruciate Ligament Reconstruction: A comparison of Patellar Tendon vs Hamstring Autograft

  Dustin J Randall, Denise Koueiter, Brandon Luczak, and Kyle Anderson

  Publication Date: 5-2-2022

  INTRODUCTION
  Choosing between a bone-patellar tendon-bone (BTB) or hamstring tendon (HS) graft for primary anterior cruciate ligament (ACL) reconstruction has long been a topic of debate and discrepancy in orthopaedic literature, with many factors contributing to the decision process. The purpose of this study is to analyze acute post-operative pain scores of patients who underwent ACL reconstruction and compare the results between BTB autograft and the HS autograft techniques.