Annual Medical Student Research Forum

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This collection contains posters and related content from the Annual Medical Student Research Forums. The Annual Medical Student Research Forum began in 1962. Citations for items published from 2021 to the present are formatted according to the Publication Manual of the American Psychological Association, 7th edition, ©2020. (Older citations are formatted according to the Publication Manual of the American Psychological Association, 6th edition, ©2010.)

Booklets prior to 2013 are available in the archives. Contact to make an appointment to access the earlier printed booklets.


The 62nd Annual Medical Student Research Forum was held January 30, 2024. Selected posters are now available in this collection.


Recent Submissions

Now showing 1 - 20 of 339
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    Choice of Anesthetic Induction Drugs for Tracheal Intubation in Critically Ill Patients and Impact on Outcomes: A Systematic Review
    (2024-01-30) Khawaja, Asad; Karamchandani, Kunal; Tyagi, Abhay; Singh, Preet Mohinder
    BACKGROUND: Airway management in critically ill patients can significantly impact patient outcomes, and the choice of induction drugs used for endotracheal intubation (TI) is key for a successful and safe airway management. However, critically ill patients often have physiologic derangements leading to complications such as hypoxemia, hypotension, arrythmias, and cardiac arrest. HYPOTHESIS: This review aims to analyze the usage and outcomes of induction drugs used for airway management in critically ill adult patients to determine if there are select induction drugs that have better success rates and patient outcomes. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for randomized controlled trials published since January 1, 2003, on critically ill adult patients who underwent TI in an emergency, ICU, or trauma setting. Our search yielded 1526 results, of which 18 were chosen. FINDINGS: These 18 studies include 15 randomized control trials, 2 ongoing phase 4 clinical trials, and 1 single blinded randomized study, for a total of 3142 patients. Etomidate and ketamine were the two most common drugs used, with 13 studies involving the use of etomidate, for a total of 1470 patients, and 7 studies involving the use of ketamine, for a total of 1082 patients. Etomidate and ketamine were compared the most frequently (n = 7), followed by etomidate and midazolam (n = 4). Most studies were performed in either the ICU (n = 6) or the ED/ER (n = 5). Hospital mortality (n = 10) and peri-intubation hypotension (n = 11) were also the most common outcomes studied. CONCLUSIONS: In general, there was no major trend that could be identified regarding patient outcomes when two induction drugs were compared with each other. This was due to the variability in the use of induction drugs for TI in critically ill patients and their patient outcomes. Comparing findings of different studies was limited by the heterogeneity of the studies. Further research is needed to identify the impact of the choice of induction drugs for TI in critically ill patients.
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    Malignant Childhood Ovarian Cancer: A Ten-Year Retrospective Review
    (2024-01-30) Laboret, Bretton; Bonnyman, Claire; Murphy, Joseph T.
    BACKGROUND: Although pediatric ovarian cancer is rare (2.1-2.6/ 100,000 females per year), 10-30% of masses are malignant. Our primary aim was to confirm the incidence and type of ovarian malignant and borderline neoplasms over a ten-year period, and to describe their presentation and clinical characteristics. Furthermore, through analysis of pre-operative workups, we sought to elucidate better predictive indicators of malignancy to help guide future treatment. METHODS: Retrospective analysis of patients (<19 years old) who underwent surgery for borderline or malignant ovarian tumors from 01/01/2009 to 12/31/2018 was performed. Patient records were analyzed for age, presentation, serum marker levels, imaging findings, treatment (surgical plan and therapy), and patient outcomes. RESULTS: A total of 42 malignant and 7 borderline ovarian tumors were included in this study. Germ cell tumors were the most common malignancy (64%) followed by stromal tumors (31%), while one epithelial mucinous tumor and one small cell tumor were found (2% each). Of the borderline tumors, serous (71 %) were more common than mucinous tumors (29%). Average patient age was 13 ± 3.9 years, and the primary presenting symptoms were pain (45%) or abdominal distension (43%). Significant elevations in alpha fetoprotein, beta human chorionic gonadotropin, lactate dehydrogenase and cancer antigen-125 serum tumor markers were noted in malignancies. Eighty-eight percent of surgeries were performed as laparotomies, and the most common operation was salpingo-oopherectomy (67%). The average tumor size was 14.6 cm. ±6.6 cm. and the majority were characterized as heterogeneous (80%). All tumors were resected, and 21 (50%) malignant tumors received postoperative chemotherapy, while no borderline cases received therapy. Average postoperative follow-up time was 38.6 months, and forty-five (92%) patients were alive at the time of data collection. CONCLUSIONS: Germ cell tumors were confirmed as the most common pediatric ovarian malignancy, followed by stromal tumors. Very few epithelial tumors were noted, as compared to prior studies. Borderline neoplasms were uncommon and had favorable outcomes. In treating pediatric ovarian malignancy, we aim to maximize patient survival while preserving fertility. We recommend a standardized preoperative workup consisting of multi-modal imaging studies and a complete tumor marker panel for all patients presenting with suspicion for an ovarian tumor.
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    Changes in Rate of Methicillin-Resistant Staphylococcus Infection in a Community Neonatal Intensive Care Unit Before and During the COVID-19 Pandemic
    (2024-01-30) Blumenfeld, Abby; Hagans, Michelle; Chan, Christina
    BACKGROUND: Methicillin-Resistant Staphylococcus aureus (MRSA) infections represent a significant healthcare challenge, particularly in neonatal intensive care units (NICUs) where patients experience increased morbidity and mortality. MRSA transmission has not been well studied in the setting of enhanced infection precautions (EIP) taken during the COVID-19 pandemic - such as universal masking and enhanced hand hygiene. OBJECTIVE: This retrospective cohort study compared rates of MRSA infection in a community NICU during two distinct time periods: January 2016 to March 2020 (Pre-EIP: before EIP was instituted) and April 2020 to December 2022 (With-EIP: after EIP was instituted). METHODS: During the study period, 74 neonates admitted to the NICU tested positive for MRSA (56 Pre-EIP and 18 With-EIP). MRSA cases were collected using laboratory and electronic medical record review. Cases were reported as infections per 1,000 patient days (IP-1000). Statistical analysis with two-sample t-tests assuming unequal variance and chi squared tests for independence were performed. RESULTS: There was a significant decrease in MRSA IP-1000 from 1.90 Pre-EIP to 0.93 With-EIP (p=0.0006). The prevalence of MRSA clusters, defined as three infections within a 30-day period, decreased from 0.27 Pre-EIP compared to 0.03 With-EIP (p=0.0004). However, The Pre-EIP cohort had a younger average gestational age (30.2 vs 33.8 weeks, p=0.001), higher rates of very low birth weight (59% vs 28%, p=0.021), and fewer inborn neonates (88% vs 100%, p=0.115) - factors known to increase risk of MRSA infection. CONCLUSION: These findings suggest that EIP may have contributed to the reduction in MRSA clusters observed in this community NICU. Findings are limited by differences in cohort risk factors, small study population, variabilities in infection precautions throughout the pandemic, and the inherent bias of retrospective cohort analysis. This underscores the importance of prevention strategies and highlights the potential benefits of continued enhanced infection precautions in reducing the transmission of MRSA in vulnerable inpatient populations.
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    Clinical Features and Outcomes of Black Patients with Melanoma: A Case Series Between 2006-2022
    (2024-01-30) Brown, Ariel B.; Wix, Sophia N.; Heberton, Meghan; Adamson, Adewole S.; Gill, Jennifer G.
    BACKGROUND: The incidence of melanoma in Black patients is rare, therefore most studies describing outcomes have been performed using population databases with limited patient-level information. OBJECTIVE: To describe specific anatomic sites, clinical features, histologic subtypes, risk factors, and outcomes of Black patients with melanoma. METHODS: Case series of Black patients with melanoma identified between January 2006 and October 2022 at University of Texas Southwestern Medical Center and Parkland Health in Dallas, TX. Participants included self-identified Black patients with a histopathologic diagnosis of melanoma. Data collection included demographics, clinical characteristics, personal and family medical history, immunosuppression history, comorbidities, histopathology reports, imaging reports, melanoma treatments and responses, time to progression, metastatic sites, and survival. Kaplan-Meier analysis captured melanoma-related survival by primary site. RESULTS: Of the 48 patients identified, the median age at diagnosis of melanoma was 61.5 (range: 23-86) with the majority being female (30/48). Seventy-five percent (30/40) of primary cutaneous melanomas were located on acral skin despite only one-third (10/30) being histologically classified as acral lentiginous melanomas. Compared to those with acral disease, patients with non-acral cutaneous melanomas were more likely to be immunocompromised (40% vs. 7%) or have a personal history of cancer (60% vs. 17%) with all (3/3) superficial spreading melanoma patients having a history of both. No patients had more than 1 confirmed primary melanoma. In total, 13 (27%) Black patients with melanoma developed stage IV disease, of which 12 ultimately died due to disease progression. Those diagnosed with advanced acral melanoma, mucosal/ocular melanoma, or unknown primary had the poorest melanoma outcomes. No patients with non- acral cutaneous melanomas developed distant metastases or died of their disease. CONCLUSION: Most cutaneous melanomas in Black patients occur on acral sites. Non-acral cutaneous melanomas had limited contribution to melanoma mortality in Black patients and were diagnosed primarily in immunocompromised patients or those with a history of other cancers. Improving melanoma mortality in Black patients will require focused therapeutic and early detection strategies for acral, mucosal/ocular, and melanoma of unknown primary.
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    Development of Deep Learning Artificial Intelligence to Detect Osteoporosis
    (2024-01-30) Fan, Christopher; Scanio, Angelo; Joshi, Parag; Öz, Orhan K.; Peshock, Ronald M.; Kay, Fernando
    Osteoporosis poses a substantial social and economic burden, with estimated treatment costs reaching a combined six trillion USD in the USA, Canada, and Europe. Although dual-energy X-ray absorptiometry (DEXA) is the diagnostic gold standard, computed tomography (CT) scans have proven to be reliable proxies for bone density measurement. Opportunistic screening for low bone density using CT obtained for other purposes can potentially reduce complications from osteoporotic fractures and health care costs. In this study, we developed an artificial intelligence (AI) algorithm using neural networks and the MONAI library to estimate DEXA bone density from non-contrast cardiac CT obtained for coronary calcium scoring purposes. A total of 2797 Dallas Heart Study phase 2 participants (39% male, 61% female) were included. The AI algorithm was first developed to automatically segment trabecular bone from cortical bone. This was trained and validated with manual segmentation of the trabecular bone by two medical students, a radiologist, using MONAI 3D autoseg. The ML algorithm achieved a Dice score of 0.97 when compared to human segmentation. A second AI model was developed utilizing segmentations of the first model. This AI was trained utilizing corresponding DEXA bone mineral density (BMD) for thoracic vertebrae. The best performing model was trained for 102 epochs, resulting in a training root mean square error (RMSE) of 0.0628 mg/cm2 and validation RMSE of 0.0842 mg/cm2. The final AI algorithm predictions yielded an R2 value of 0.71 compared to DEXA (Figure 1). Our findings underscore the clinical feasibility for an automated neural network to predict DEXA scores from non-contrast cardiac CT. This approach may help in the early detection of unsuspected low bone mineral density in patients undergoing CT scans for other reasons, allowing for potential improvements in patient outcomes and resourceful utilization of diagnostic imaging.
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    Trends and Variations in Tracheal Intubation for Acute Respiratory Failure in the US
    (2024-01-30) Iancau, Alexander; Rosero, Eric B.; Karamchandani, Kunal
    BACKGROUND: Acute respiratory failure (ARF) is a critical medical emergency with increasing mortality rates and hospitalizations in the United States (US). Tracheal intubation (TI) is often required to provide mechanical ventilation in these patients. However, recent evidence shows that TI in critically ill patients is associated with substantial morbidity and mortality, and hence, understanding trends and variations in the practice of TI in critically ill patients with ARF is crucial for improving patient outcomes and healthcare practices. HYPOTHESIS: The study aims to evaluate the frequency of TIs in ARF patients and to assess trends and variations in TI use across US hospitals. We hypothesize a declining trend in TIs among ARF patients and significant variability in TI utilization across US hospitals. METHODS: In our retrospective cohort study, we utilized the National Inpatient Sample (NIS) database from the HCUP. Patient selection relied on ICD 10th Revision codes to identify critically ill adults aged 18 and above who underwent TI and were diagnosed with ARF (2016-2020). We also extracted patient demographic and hospitalization details from the database. RESULTS: From 2016-2020, 2,531,420 patients were admitted to US hospitals with ARF, and of these, 522,746 underwent TI (26.02%). The mean age was 62 years, 44.4% were women, and the in-hospital mortality was 32.8% (95% CI, 32.6%-33.0%). The mortality among patients receiving TI increased significantly from 30.6% (95% CI, 30.1%-31.1%) in 2016 to 37.8% (95% CI, 37.3%-38.3%) in 2020 (p<.0001). However, the percentage of ARF-related hospitalizations receiving TI decreased from 23.9% (95% CI, 23.4% - 24.4%) in 2016 to 18.9% (95% CI, 18.5% - 19.3%) in 2020 (p<.0001). CONCLUSION: We found a decline in TI use for patients with ARF across hospitals in the United States. This could be due to the increased use of alternative techniques to manage ARF, such as non-invasive ventilation and high-flow nasal cannula.
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    Training through a Novel Community-Engaged Research Project to Reduce Pregnancy-Associated Morbidity and Mortality from Maternal Sepsis in New York City
    (2024-01-30) Zhao, Alice; Richardson, Briana; LaHote, Jessica; Oktem, Ayda; Plumlee, Austin; Hall, Kelli Stidham
    Maternal sepsis is the second-leading cause of maternal mortality in the U.S., with a disproportionate impact among racial and ethnic minorities. Although maternal sepsis is largely preventable, there remains little evidence concerning the management of risk factors to ensure safe and equitable maternal care during delivery and transition to postpartum. The EnCoRe MoMS study (Engaging Communities to Reduce Morbidity from Maternal Sepsis) is a comprehensive, community-engaged project focused on reducing pregnancy-associated sepsis risk and promoting maternal health equity in NYC. Community stakeholders are integrated in the community research design process through the Community Organization Leadership Advisory Board (CoLAB). I aimed to contribute to the qualitative portion of the ongoing EnCoRe MoMS study to better understand how the social determinants of health impact the lived experiences of patients and how qualitative interviewing can uncover specific barriers and proposed solutions that may be implemented across the pregnancy continuum. We developed an efficient workflow for the recruitment, consent, and enrollment of patients, then conducted qualitative in-depth interviews (IDIs) with postpartum patients and community focus group discussions (FGDs). Major themes explored during IDIs included prenatal and labor/delivery experiences, facilitators/barriers to accessing quality maternal care, respectful care, community-based resources and solutions, etc. (see table). Ultimately, qualitative data collection through IDIs and the FGD allowed us to observe the lived experiences of patients at high risk of pregnancy and postpartum complications, including sepsis.
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    Assessing Disease Severity in Cutaneous Lupus Patients Using Natural Language Processing
    (2024-01-30) Wang, Laura; Nezafati, Kuroush; Rong, Ruichen; Park, Andrew; Zhu, Jane; Xiao, Guanghua; Xie, Yang; Yang, Donghan M.; Chong, Benjamin F.
    BACKGROUND: Cutaneous lupus erythematous (CLE) is an autoimmune skin disorder that manifests as inflammatory cutaneous lesions commonly in photosensitive areas. It is often chronic in nature, with exacerbations that can lead to hyperpigmentation and scarring. One tool used to measure disease activity and damage in CLE patients is the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) score. There has been little work done previously using natural language processing (NLP) in dermatology to assess disease severity, though there is promising potential for its use given the role of narrative data in dermatology. OBJECTIVE: We aim to develop a NLP model that interprets physical examination (PE) documentation in CLE patients and computes disease severity scores in the form of CLASI activity and damage scores. METHODS: Dataset was derived from 50 patients enrolled in the UTSW CLE registry. 89 clinical exams of 24 patients were used in a training set, used to train the NLP model. 35 clinical exams of 26 patients were selected for a validation set, used to test the model's accuracy in prediction. An entity dictionary was defined that provided rules for labeling vocabulary pertinent to CLASI scores within the PE note. This was used to label the relationships between entities in the training and validation sets. The BERT (Bidirectional Encoder Representations from Transformers) model was trained to predict all entities and relationships in the notes, based on which the CLASI scores were calculated. After training, the model was applied to the validation set. In evaluation, scores generated from the model were compared to the ground-truth CLASI scores based on human annotation. RESULTS: The model-predicted scores had a correlation of 0.79 and 0.86 with the ground truth on the activity and damage scores, respectively, in the training set, and a 0.61 and 0.79 correlation in the validation set. The model had 0.84 and above for accuracy, recall, precision and F1 within the sub-goal of determining the category of score severity (high or low), for both training and validation sets. CONCLUSIONS: Using PE notes as the input, a BERT-based NLP model can be trained to predict CLASI scores in CLE patients. If successfully implemented, this algorithm can significantly increase the volume of real-world data available for CLE research by efficiently processing PE notes in the EHR. Future steps are to increase the size and representation of the training set to improve accuracy and external validity of BERT's predictions.
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    Effect of ULK1 Inhibition on Corneal Epithelial Cells During Pseudomonas aeruginosa Infection
    (2024-01-30) Abdallah, Joelle; Ayilam Ramachandran, Rajalakshmy; Robertson, Danielle M.
    INTRODUCTION: Pseudomonas aeruginosa (PA) keratitis is a severe infection of the cornea that can lead to blindness. Studies in our lab have shown that PA exploits autophagy, a major cellular degradation process, in corneal epithelial cells (hTCEpi cells) to promote intracellular survival. We have further shown that the inhibition of autophagy by the Unc 51-like kinase (Ulk1), an enzyme that mediates formation of the autophagosome, reduces intracellular levels of PA. More recently, we have demonstrated that PA infection negatively impacts host mitochondria. ULK1/2 has been reported to translocate to mitochondria to mediate mitophagy however, a role for ULK1/2 in mitochondrial homeostasis during infection has not yet been explored. In this study, we investigated the effects of the inhibition of Ulk1 during PA infection on host mitochondria. METHODS: Telomerase-immortalized human corneal epithelial (hTCEpi) cells were used for this study. Cells were cultured in serum-free defined keratinocyte media with growth supplements. Cells were inoculated with 106 CFU/ml of PA in log growth phase with or without treatment with 1 �M of the Ulk1/2 inhibitor MRT68921. Intracellular levels of PA were quantified using a gentamicin survival assay. Oxygen consumption and mitochondrial polarization were assessed using Seahorse metabolic flux analysis and tetraethyl-benzimidazolyl-carbocyanine iodide (JC-1), respectively. Levels of pro-inflammatory cytokines were assessed using ELISA. Untargeted metabolomics was performed using mass spectrometry. Cellular changes were further evaluated using transmission electron microscopy (TEM). RESULTS: PA infection induced robust mitochondrial depolarization. There was a corresponding increase in secretion of IL-6 and IL-8. Treatment with MRT68921 restored mitochondrial polarization and reduced IL-6, but had no effect on IL-8. MRT68921 also reduced intracellular levels of PA. TEM demonstrated robust mitochondrial fission during PA infection. Treatment with MRT68921 preserved mitochondrial structure and polarization during PA infection. CONCLUSIONS: Taken together, these data suggest that Ulk1/2 modulates the host mitochondrial response to PA infection. Further studies are needed to determine the mechanism by which MRT68921 preserves mitochondrial function and its potential use as an adjunct therapeutic for PA-mediated keratitis.
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    Delivery Continuity and Neonatal Disposition to Birthing Parent in Individuals with Substance Use Disorder at Parkland Health
    (2024-01-30) Afsari, Macy; White, Alesha; Morillos, Stephanie; Fisher, Amber; McNeil, Jessica; Faucher, Mary Ann; Cordova, Polly; Onisko, Nancy S.; Andino, Aldo; Kern, Joshua; Kleinschmidt, Kurt; McIntire, Donald D.; Adhikari, Emily H.
    OBJECTIVE: Infants born to individuals with substance use disorder (SUD) are at increased risk of removal from their parent. Individuals with SUD in pregnancy receive obstetric care by a multidisciplinary care team (MCT) at our safety-net hospital. We evaluated factors associated with delivery continuity and neonatal discharge to birthing parent among patients with SUD. STUDY DESIGN: This is a retrospective cohort study of pregnant patients with SUD who accessed Parkland Health (PHHS) between July 28, 2021 and June 25, 2022. We compared MCT interactions among patients who did and did not deliver at PHHS as well as neonatal disposition and outcomes for infants born to individuals with SUD and with specifically opioid use disorder (OUD). RESULTS: Among 256 pregnant individuals with SUD who accessed care in our system, 144 (56%) received care by our MCT during pregnancy or at the delivery hospitalization. 98 of these patients delivered at PHHS and 46 delivered elsewhere (68% vs 32%, p<0.001). Significantly more eligible individuals who delivered at PHHS accepted medication-assisted treatment (MAT) compared to those who did not (88% vs 70%, p=0.025). Of 139 patients with SUD who delivered at PHHS, 91 (65%) infants were discharged home with the birthing parent. Parents who went home with their infants were more likely to use cannabis (33% vs 4%, p<0.001) and less likely to use opioids (34% vs 63%, p=0.003). They attended more prenatal visits (median [IQR] 9 [5,11] vs 1 [0,4], p<0.001) and met less frequently with our multidisciplinary team providing integrated SUD treatment (1 [0,10] vs 4 [1, 14.5], p=0.026). Neonates discharged with the birthing parent were less likely to have a positive meconium (7% vs 75%, p<0.001) or urine toxicology (2% vs 67%, p<0.001) and were less likely to have a 5-minute Apgar <4 (0% vs 4%, p=0.04). Of 62 patients with OUD, 31 (50%) were discharged with their neonate. Those who used opioids alone were more likely than individuals with opioid-polysubstance misuse to retain charge of their infant (78% vs 43%, p=0.018). CONCLUSION: Increased interactions and MAT with a team specializing in care of pregnant patients with SUD is associated with delivery continuity. Neonatal disposition and outcomes are influenced more by maternal drug of choice and prenatal care attendance than by MCT interactions because of variance in SUD complexity. Opioid-polysubstance misuse is associated with separation of maternal infant dyad.
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    Late Presentation of Complications of Mid-Urethral Slings and Outcomes After Sub-Urethral Sling Removal
    (2024-01-30) Suzman, Evan; Shah, Anjana; Alhalabi, Feras; Christie, Alana; Zimmern, Philippe E.
    INTRODUCTION: Mid-urethral slings (MUS) are common procedures for surgical management of stress urinary incontinence (SUI) in women and have recognized complications, which are often underdiagnosed if they occur late and may result in complex care even after sub-urethral sling removal (SSR). This study focused on the evaluation of MUS complications occurring 10+ years after placement, and outcomes after sling release. METHODS: Demographics, past medical history, original MUS operative note, presenting symptoms, pre-SSR evaluation, peri-operative complications, post-SSR symptoms at last visit, were collected from EMR (EPIC) for patients who underwent SSR at least 10 years after MUS placement. For those not seen in the past 2 years, a standardized phone interview using validated questionnaires was performed by a neutral investigator not involved in the care of these patients. RESULTS: From 2006 to 2023, 58 patients met study criteria with mean age of 65 ± 10.5 years and predominantly Caucasian (91%). Nine were reached by phone and 4 were lost to follow-up. Time from initial MUS procedure to SSR removal was 16.7 ± 3.9 years. Most MUS were TVT (76%), followed by TOT (18%). At presentation, 90% of patients reported pain, 86% dyspareunia, 69% recurrent UTI, 52% SUI, and 53% urge urinary incontinence. Multiple presenting symptoms were observed in 83% of patients. At a mean follow-up of 2.2 years, SSR resulted in resolution of pain in 50% of patients, dyspareunia in 50%, recurrent UTI in 60%, SUI in 29%, and urge urinary incontinence in 37%, for each respective initial symptom. Some patients reported de novo pain (3%), UTIs (2%), SUI (9%) or urge urinary incontinence (7%). 7% required subsequent surgery for UI or persistent pain-related issues. CONCLUSIONS: It is important that pelvic reconstructive surgeons monitor patients who receive MUS over time and counsel patients considering MUS on these potential risks.
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    The University of Texas Southwestern Medical Center 62nd Annual Medical Student Research Forum
    This 140-page booklet includes a list of oral presentations, a table of contents to the abstracts, and the abstracts divided into three categories: Basic Research and Disease Models; Clinical Research; and Quality Improvement, Global Health, Medical Education, Community Health, and Research Design.
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    Surgical and Conservative Treatment Approaches in Cases of Central Cord Syndrome: A Systematic Review and Meta-Analysis
    (2024-01-30) Venkatesh, Pooja; Jenkins, Abigail; Anand, Soummitra; Farid, Michael; Bah, Momodou G.; Barrie, Umaru; Wilson, Remi; Hall, Kristen; Caldwell, Christie; Al Tamimi, Mazin; Aoun, Salah
    INTRODUCTION: Management of central cord syndrome (CCS) is still controversial. This study aimed to examine the roles and timing of conservative and surgical management in CCS. METHODS: A systematic review was conducted according to the PRISMA guidelines to identify articles describing the use of conservative and/or surgical methods in the management of CCS. Data extracted was subsequently meta-analyzed. RESULTS: A total of 37 articles detailing 99 cases of adult CCS were identified with 79 males and 20 females. Patients receiving surgery were all female patients (100% vs. 0%, p<0.05), and had higher rates of established spondylosis (43.2% vs. 11.8%, p<0.05). Conservative management was more frequent in cases of CCS from sports trauma (35.3% vs. 1.23%, p=0.0000) and in patients presenting with upper extremity motor deficits at presentation (94.1% vs. 50.6%, p<0.01), symptoms of pain (52.9% vs. 21%, p<0.05), and autofusion on diagnostic imaging (29.4% vs. 1.23%, p=0.0001). Predictors of surgical intervention included a time lapse of >24 hours after injury (p<0.001, OR: 17.18, 95% CI: 3.00-182.81) and spondylosis on diagnostic imaging (p<0.01, OR: 8.84, 95% CI: 1.82-86.09). Additionally, surgical intervention was found to be less likely with increased patient age (p<0.01, OR: 0.96, 95% CI: 0.93-0.98). Meanwhile, sports trauma was a predictor of conservative management (p<0.001, OR: 0.03, 95% CI: 0.00-0.29). There was no statistically significant difference in symptomatic improvements between the two management strategies (87.7% vs 100%, p=0.2765). CONCLUSION: Understanding these predictors and outcomes can aid in personalized treatment decisions for CCS cases. Early surgical intervention within 24 hours of injury does not appear to be superior to conservative management with possible deferred operation.
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    Targeting Cilia Initiation & Maintenance in SHH-Medulloblastoma
    (2024-01-30) Popokh, Benjamin
    Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Of the four molecular subtypes, Sonic Hedgehog Medulloblastoma (SHH-MB) involves aberrant growth signaling between SHH mitogen and its receptors on primary cilium in cerebellar granule cells. We hypothesized that in mouse models genetically engineered to induce SHH-MB, additional genetic modifications dysregulating primary cilium would inhibit the cancer phenotype, either decreasing severity or preventing it altogether. We established breeding cages with conditional knockouts of Gpr161 (GPR161 normally represses SHH signaling, knockout promotes SHH-MB), knockouts of Ptch1 (a SHH receptor with more aggressive tumors upon haploinsufficiency), and Pcm1 knockouts (centriolar satellite protein critical for primary cilia stability). Our methods included: PCR and gel electrophoresis to assess genotype, BrdU injections, cerebellum dissection, cryo-sectioning, antibody staining, and immunofluorescence imaging using confocal microscopy. We immunostained cerebellar tissues from various genotypes with cell cycle (CyclinD1), primary cilia (ARL13B), mitotic (pHH3), and proliferative markers (BrdU). We found that mice with Gpr161 or Ptch1 deletion develop SHH-MB and "persistent" external granular layers with increased cilia density versus controls. There is also a large presence of BrdU (-) and CyclinD1 (-) cells with cilia, begging the question of where in the cell cycle these cells belong. Heterozygous deletion of Pcm1 (+/ko) does not appear to diminish cancer phenotype, as a Ptch1 +/ko; Pcm1 +/ko mouse demonstrated SHH-MB and increased cilia density. A full knockout of Pcm1, however, does seem to rescue the cancer phenotype, as a Gpr161 f/f; Pcm1 ko/ko; Nestin-Cre mouse did not have any tumor, and it had low cilia density. We demonstrate that in mice with SHH-MB-predisposing genetic mutations, additional mutation of proteins regulating stability of primary cilia might prevent cancer phenotype. These results could open an avenue for investigating therapeutic inhibition or downregulation of cerebellar primary cilia in human patients with genetic predisposition for SHH-MB.
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    Systematic Review of the Global Literature on Uncomplicated Recurrent Urinary Tract Infections: Underscoring Major Heterogeneity
    (2024-01-30) Papp, Sara B.; Seyan, Zheyar; Khan, Zara; Kenee, Parker R.M.; Christie, Alana; Zimmern, Philippe E.
    INTRODUCTION: Urinary tract infections (UTI) are common infections affecting over 60% of women and often become recurrent (rUTI). Despite their prevalence, research on rUTIs is limited and results are heterogenous due to varying definitions and populations. This systematic review examines global literature on uncomplicated rUTI and assesses differences in data based on geographic region. METHODS: Databases PubMed, Embase, WHO Global Index Medicus, and SciELO were searched for the keywords and/or MESH terms for recurrent and UTI, 2000- 2023. Studies were restricted to females ≥18 with uncomplicated rUTIs. Studies were excluded if they did not provide a definition for rUTI or did not cite/report an estimate for rUTI prevalence. The review was registered in PROSPERO and conformed to PRISMA. RESULTS: The search yielded 2,947 studies of which 124 were included (Table 1). Most studies were conducted in Europe (41%) or North America (39%), were prospective (52%), at tertiary centers (49%) and included all age groups (60%). Public institutions were the most common in North America (67%) while multi-center and public institutions were equally frequent in Europe (39% each). The most common definition for rUTI was 2 UTI/6m or 3 UTI/1y (62%). Regardless of study location, most studies cited prevalence estimates for rUTI from U.S.-based populations. Convenience samples were used for 91% of studies and sample sizes were: 30% n<50, 29% n=50-99, 22% n=100-199, 36% n≥200. CONCLUSIONS: This study represents the first formal investigation of the global literature base on uncomplicated rUTI. Studies on rUTIs are globally of small scale and definitions used for rUTI are heterogeneous. More studies are needed to ascertain the true prevalence of rUTI outside of North America and Europe.
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    Standardizing Treatment for Acute Exacerbations of COPD (AECOPD) at a Large Academic Hospital
    (2024-01-30) Peraka, Veena; Wootton, Taylor; Irving, Annette
    BACKGROUND: Acute exacerbations of COPD (AECOPD) are a common problem faced by patients with chronic obstructive pulmonary disease (COPD). There are discrepancies in AECOPD treatment that impact patient outcomes. Despite evidence of improved or non-inferiority outcomes and reduced cost with short oral regimens, steroid prescribing patterns remain variable. Furthermore, there is confusion regarding antibiotic choice that contributes to the problem. LOCAL PROBLEM: The local problem is the lack of standardization of care for AECOPD at Clements University Hospital (CUH). Data from 6/1/2021-5/31/2023 shows that AECOPD treatment at CUH has been variable despite the availability of evidence-based medications. AIM: The aim of this project is to improve the adherence to evidence-based selection of steroids and antibiotics for AECOPD at CUH by 75% at 1 year after the intervention along with a 10% decrease in length of stay and readmissions. METHODS: The intervention is an order set containing guidelines and treatments for AECOPD that can be implemented into Epic electronic health records. Emergency department physicians, hospitalists, and pulmonologists were consulted for insight about treatment recommendations. This advice along with the GOLD guidelines and additional research were used to create the order set. RESULTS: The order set is now ready for implementation into Epic after being presented to physicians and respiratory therapists for feedback. After implementation, data will be collected on the usage and effectiveness of the order set and analyzed for up to one-year post-intervention. CONCLUSION: AECOPD is a complex disease that is treated with various medications that can lead to the different outcomes. Insight from various physician specialties was helpful to understand methods at CUH at different stages of the AECOPD journey. Due to the complexity, the order set can be a helpful resource for physicians when choosing treatments to improve adherence to evidence-based medications and patient outcomes.
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    How Learning Strategies and Academic Parameters Predict Medical Student Success
    (2024-01-30) O'Connell, Michael; Badia, Rohit; Tellez, Juan; Cook, Grayden; Sachs, Arlene
    BACKGROUND: Student scores on the Learning and Study Strategies Inventory (LASSI), an assessment of academic skills, have been shown in previous studies to be significantly different between U.S. medical students based on their scores in various examinations during the preclerkship curriculum. This study aimed to evaluate LASSI and other early academic performance markers for predicting the likelihood of shelf exam underperformance in third-year medical students. METHODS: A retrospective analysis of student-specific demographic information and medical school exam performance from 220 medical students from the University of Texas Southwestern was performed. Students were then categorized based on underperformance (score in <25th percentile) on each NBME shelf exam and statistical analysis was performed to identify predictors of shelf underperformance. RESULTS: For predicting Surgery shelf underperformance, pre-clerkship final exam average (PCA), STEP 1, and LASSI Time Management (TMT) were statistically significant in univariate analysis. Internal Medicine: PCA, STEP 1, LASSI Attitude (ATT), Test Strategies (TST), and TMT. Pediatrics: PCA and STEP 1 quartile. Obstetrics-Gynecology: PCA, STEP 1, and LASSI Anxiety (ANX), with ANX an independent predictor on multivariate analysis. Neurology: PCA, STEP 1, LASSI ANX, Information Processing (INP), TST, and average LASSI, with PCA, LASSI Concentration (CON), TMT, and ANX independent predictors on multivariate analysis. Family Medicine: PCA, STEP 1, LASSI ANX, TST, and Using Academic Resources (UAR), with PCA an independent predictor on multivariate analysis. Psychiatry: only STEP 1 was significant. CONCLUSION: In contrast to previous studies, no single LASSI scale was significantly associated with underperformance on all 7 NBME shelf exams. Univariate analysis identified several LASSI scales that correlated with NBME underperformance, but the drastic inter-clerkship heterogeneity makes use of these scales in early academic intervention impractical. Conversely, PCA was found to be strongly associated with shelf exam underperformance.
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    Incorporating Real-Time Audiovisual and Haptic Feedback in a Novel Thoracostomy Tube Training Model
    (2024-01-30) Najjar, Alex; Hegde, Shruti; Hofman, Emily; Dubagunta, Sruthi; Awad, Daniel; Khan, Omar; Eisaman, Kraigen; Hossain, Ifti; Walker, James; Sherman, Bradley; Kadakia, Yash; Park, Caroline
    INTRODUCTION: Simulation-based training can enhance clinical performance, but chest tube insertion is challenging to simulate due to the precision needed for controlled pleural entry. This study evaluates the efficacy of a novel training model with real-time pressure monitoring and audiovisual feedback for force and time to pleural entry in a model. METHODS: The model consisted of a Kelly clamp with force sensors installed at the index finger (sensor 1) and both finger loops (sensors 2 and 3) and a manikin with a replaceable chest wall pad. Data obtained from experts indicated standard force value for pleural entry (Newtons, "N") and acceptable time to completion (3000-5000 milliseconds, "ms"). Thirteen participants ranging from PGY-1 to PGY-6 were introduced to the procedure and model. Force and time were measured from dermal entry to pleural space puncture. A significant drop in pressure suggested puncturing through the chest wall. RESULTS: Force was measured in the linear, plateau, and drop phases of the procedure. Linear phase (~3,000ms) was from start to point of maximum force (<30N). Plateau phase was from maximum force until drop phase. Drop phase was a drop in pressure by >5 Newtons within 150ms indicating procedure completion (pleural entry). All participants successfully completed the task. Pleural entry force ranged from 17N to 30N, and time to pleural entry ranged from 7,500-15,000ms. Of note, left-handed participants relied more on sensors 1 and 3 while right-handed participants relied more on sensors 1 and 2. Thus, only force measurements from sensor 1 were utilized to standardize our assessment. CONCLUSIONS: This novel chest tube trainer with continuous force monitoring can be applied to training for a variety of scenarios, including vascular access, trocar placement and other common procedures. Next steps involve evaluating its impact on trainee accuracy and efficiency.
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    Visual Outcomes after Intraocular Foreign Body Injuries at Parkland & UT Southwestern Hospitals and Clinics
    (2024-01-30) Mohan, Navnit; Ashkenazy, Noy
    BACKGROUND: Intraocular foreign bodies (IOFBs) make up a large portion of open globe injuries and can cause severe vision loss. IOFBs entrapped in the posterior segment are a particularly significant cause of greatly diminished visual acuity and legal blindness (VA<20/200), prompting analysis of the factors that may influence visual outcomes. OBJECTIVES: The purpose of our study is to determine how surgical approach (single vs. staged surgical repair) may affect visual outcomes for patients with traumatic posterior segment IOFB injuries. We also examine whether patients presenting with specific vision-threatening sequelae are more or less likely to undergo a specific surgical approach. Additionally, we record incidence data on different IOFB material types, mechanisms of injury, and the use of safety glasses. METHODS: This is a retrospective chart review with a target population of patients 18-85 years old who were surgically treated for traumatic posterior segment IOFB injuries at Parkland and UT Southwestern from 6/1/2011 to 5/23/2023. 53 patient records accessed through Epic Systems met inclusion criteria. 12 patients underwent single surgical repair and 41 underwent staged repair, suggesting a hospital/ systemwide preference in surgical approach. RESULTS: Our results did not find a significant difference between initial visual acuity (t-stat=-0.953, p=0.288), final visual acuity (t stat=-1.075, p=0.297), or change in visual acuity (t-stat=0.056, p=0.954) between single and staged repair groups. Among 19 different vision-threatening sequelae examined, patients presenting with scleral laceration (p=0.0378) and vitreous hemorrhage (p=0.0245), were significantly more likely to undergo staged surgical repair, while those presenting with endophthalmitis (p=0.0073) were more likely to undergo single surgical repair by Fisher's exact test. The IOFB material types were metallic (89%), glass (7%), and stone (4%). Hammering was the most common mechanism of injury, accounting for 30.2% of cases. Data on safety glasses use was available for 20 patients, amongst whom 25% affirmed and 75% denied use. CONCLUSIONS: Our data suggest a predominance of IOFBs of metallic origin and a skew towards staged surgical repair for patients at Parkland & UTSW hospitals and clinics. The poor use of safety glasses within the data collected underscores the necessity of emphasizing eye protection in metal work and other high-risk occupations. Given the small sample size of our study, more data may help better elucidate visual outcome differences based on repair type and provide further insight into specific sequelae that increase the likelihood of a particular surgical approach.
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    ChatGPT Responses to Glaucoma Questions Based on Patient Health Literacy Levels
    (2024-01-30) Mekala, Priya; Patel, Monica; Suresh, Sruthi; Saleh, Ibrahim; Kooner, Karanjit
    BACKGROUND: Glaucoma is a complex, progressive neurodegenerative disease of the optic nerve, commonly found in the elderly. Patients usually do not understand the complexities of the disease and struggle to find answers from different glaucoma sources and sites which may be difficult to understand. AI chatbots such as ChatGPT(r) have recently emerged as a useful tool to gather information on any medical question. However, the role of ChatGPT in generating answers to glaucoma treatment questions is not well documented. Health literacy is defined as the basic reading and mathematical skills required to find, understand, and use health-related information. The average reading level among US adults is 7th-8th grade; however, most medical information is often written at a higher reading level. The purpose of this study was to determine whether ChatGPT can tailor responses to glaucoma treatment questions based on patient health literacy levels. HYPOTHESIS: We hypothesize that ChatGPT may satisfactorily tailor answers to glaucoma questions based on patient health literacy level. METHODS: We selected 27 common questions relating to glaucoma medications, lasers, and surgical treatments. The questions were inputted into ChatGPT, first without instructions. Then, ChatGPT was instructed to tailor responses to 4 health literacy levels based on the US National Assessment of Health Literacy: below basic (BB), basic (B), intermediate (I), and proficient (P). Responses were analyzed using Flesch-Kincaid (FKC) grade level [0-18+] corresponding to years of education, word count, and syllables. Kruskal-Wallis rank sum tests were used to analyze the data. RESULTS: The mean FKC grade level of ChatGPT responses without any instructions about health literacy levels was 12.83, corresponding to a 12th-grade or "fairly difficult to read" level. When instructed to tailor responses, the mean FKC grade level of BB, B, I, and P responses were 11.50, 12.49, 12.95, and 13.12 (p<0.001), respectively. The mean word count of BB, B, I, and P answers (82, 117, 163, 177, respectively) correspondingly increased (p<0.001). CONCLUSION: ChatGPT in its current form is unable to provide easy to comprehend responses to glaucoma questions for the public. Future AI chatbots may need to be trained on not only the specific databases, such as medical, conversational, computer science, and finance, but to be able to provide easily understandable answers at all levels of health literacy to cater to a wider sector of society.