Poster Day 2024: Abstracts: Clinical Research

Pembrolizumab, a monoclonal antibody targeting PD-1, has revolutionized cancer treatment by enhancing anti-tumor immunity. Despite its effectiveness, pembrolizumab can induce immune-related adverse effects (irAEs), including rare cutaneous reactions such as lichenoid dermatitis. This report presents a case of a 67-year-old female with stage IV lung adenocarcinoma who, after receiving carboplatin, pemetrexed, and pembrolizumab, developed a pruritic rash that evolved into nodular, scab-forming lesions. A biopsy confirmed lichenoid dermatitis. The rash responded to treatment with systemic prednisone, topical triamcinolone, and antihistamines. Following imaging that revealed disease progression, pembrolizumab was discontinued, and the patient was switched to docetaxel and ramucirumab. This case highlights the need for timely recognition and management of lichenoid dermatitis as an irAE of pembrolizumab, emphasizing that while corticosteroids are often effective, alternative treatments may be necessary for steroid-resistant cases.

Natural and synthetic progestins increase transcriptional expression of pri-miR-190 and pri-miR-199a-1 through processes directly dependent on the progesterone receptor. Both microRNAs tested can be potential biomarkers in progesterone receptor positive breast cancers.

This study demonstrates the efficacy of robotic gastric bypass surgery in alleviating symptoms of GERD amongst bariatric patients. Robotic gastric bypass should be heavily considered in obese patients presenting with chronic symptoms of GERD.                 

Many individuals present symptomatically and asymptomatically with first rib (FR), acromioclavicular joint (ACJ) subluxation. This project displays the effectiveness of treating AC J-FR subluxation somatic dysfunction.       

This project was a quasi-experimental pre-and-post experimental design with 20 students, 10 male and 10 female. A goniometer assessed range of motion (ROM). The shoulder was abducted 90 degrees (90D), flexed 15 degrees (15D), elbow stabilized in 90D flexion with internal rotation (IR) of the shoulder during hand pronation. Lack of motion was assessed at end ROM. Cervical region restriction is a lack of rotation, 15D or more, toward the side of the subluxed FR. Pressure was applied to the FR, depressing it downward towards the sterno-clavicular joint (SCJ). Medial-superior manual pressure was simultaneously applied to the ipsilateral ACJ while flexing the ipsilateral shoulder 90D, and raising the arm superiorly, allowing the FR, clavicle, and ACJ to regain physiologic positioning. The patient's head was continuously positioned downward, rotated contralateral to the dysfunctional side. The researcher moved the flexed arm slightly above and behind the patient's head as the patient concurrently exhales, repeating the technique as needed. 

This technique alleviated the 15D pre-corrective restrictions with ipsilateral cervical rotation and restoration of the pre-corrective 15D loss of ROM with IR of the shoulder. Means and ratios were used to demonstrate significance and improvement. 

Treatment re-establishes full ROM with ipsilateral cervical rotation and IR of the shoulder. Clinical findings remained consistent regardless of age or gender. FR subluxation appears ubiquitously and can be treated with OMM. 

Our research indicates that mortality reminders serve to strengthen nonconscious perceptions and behaviors held by medical and nursing students. Therefore, students may benefit from mortality topics in the curriculum to better approach teamwork and patient care with more confidence, awareness and professional maturity.                       

Polycythemia Vera (PV) with Chronic Lymphocytic Leukemia (CLL) is a rare phenomena that has been documented in a few rare cases. The clinical course in most documented cases has been mild. Our patient was noted to have pancytopenia after undergoing irrigation and debridement of her right hand. Further testing revealed patient was JAK2 positive. Treatment with hydroxyurea was initiated. Bone marrow biopsy and follow up after 5 months showed CLL phenotype and FISH with 13q deletion. Our patient could support a hypothesis that PV and CLL share a common signaling pathway that could cause both neoplasms to occur concurrently.  

Micronutrients are essential for maintaining health and preventing serious medical conditions, and are commonly deficient in the U.S. population. Learning to recognize vitamin deficiencies begins in medical school and is especially significant for osteopathic medical students, as more than half of graduates enter primary care fields. Establishing the extent of current knowledge within osteopathic medical students is important for determining the need for additional nutrition education for these students.

This study surveyed medical students at the Alabama College of Osteopathic Medicine. Respondents (n=70) included 34 OMS-I (49%), 15 OMS-II (21%), 10 OMS-III (14%), and 11 OMS-IV (16%) students. The study assessed prior exposure and confidence in nutritional education, then evaluated knowledge of the functions of vitamin B, vitamin D, magnesium, and folate and the likelihood of prescribing these micronutrients to future patients. A t-test and ANOVA of the data was performed, utilizing a value of 𝛂 = 0.05.

79% of students have some education in nutrition, but only 53% feel confident in their knowledge. All p-values were significant when comparing micronutrient knowledge of pre-clinical students (OMS-I and OMS-II) to post-clinical students (OMS-III and OMS-IV), implying that students learn as they advance through medical school. This is complicated by evidence that some micronutrients show greater learning gains, meaning education in certain micronutrients is being prioritized. Students are overwhelmingly interested in recommending micronutrients to their future patients, strengthening the argument for expanding micronutrient education. Medical students support further micronutrient education, with 97% showing interest in learning more about this subject.

A scoping review was conducted using the PRISMA-ScR guidelines. Resources utilized for the review included PubMed and Embase. Articles included were required to be original research, published in English, conducted on human subjects, published in the last 15 years, had full text available, and included treatment with naltrexone in an off-label capacity (i.e. not for the treatment of alcohol or opioid use disorder). Zotero, a reference management software, was used to review all search results with this criterion.

The articles selected presented clinical examples of LDN efficacy for a variety of medical conditions. This review indicates LDN could be a safe and cost-effective treatment option for several of these conditions. These articles also helped to illuminate the current gaps in research, pointing to the need for larger clinical trials and proper dosing studies.

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While guidelines were updated in July of 2023, suggesting certain testing before and during treatment, there may be further information to be aware of before initiation of Remdesivir. The most notable concerns throughout these studies were the risk of renal impairment, bradycardia, and hepatotoxicity. Many studies reported concerns of these symptoms following the initiation of Remdesivir. However, several studies reported that many of the adverse effects presented could be manageable if proper precautions are taken

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This pilot study will give us insight into the potential academic uses of neurofeedback. In addition, it will help determine the most accessible, efficient neurofeedback protocol. Feasible, effective use of neurofeedback may foster more focused work, efficient study, and positive mental health.

Copper deficiency is an uncommon but critical factor in respiratory muscle weakness, particularly in patients with a history of gastric bypass surgery, which can impair nutrient absorption. This case report details the clinical course of a 49-year-old male with a history of Roux-en-Y gastric bypass who experienced prolonged mechanical ventilation following a respiratory illness. Despite improvement in his primary condition, the patient remained ventilator-dependent, with persistent muscle weakness and difficulty weaning. Further investigation, including micronutrient analysis, revealed severe copper deficiency. Copper repletion therapy was initiated, leading to marked improvement in respiratory muscle function and successful weaning from ventilatory support. This case emphasizes the need to consider micronutrient deficiencies, such as copper, as contributing factors in patients with previous bariatric surgery who present with unexplained respiratory failure and prolonged ventilator dependency. Early recognition and treatment of copper deficiency could be essential in managing similar cases and reducing ventilator-associated morbidity.

Adult-onset ventricular septal defect (VSD) is a rare and complex condition that presents unique challenges in diagnosis and management. This case report describes a 65-year-old patient with a newly identified VSD resulting in heart failure symptoms and significant hemodynamic instability. The patient’s clinical course was marked by episodes of decompensated heart failure, pulmonary hypertension, and cardiac ascites, complicating the management strategy. Diagnostic imaging confirmed the presence of a moderate VSD with left-to-right shunting. Given the patient's age, comorbidities, and surgical risks, a multidisciplinary team considered both conservative medical therapy and surgical intervention, including transcatheter repair options. However, the risks associated with intervention were high, underscoring the complexity of decision-making in elderly patients with acquired VSD. This case highlights the importance of individualized, multidisciplinary management approaches in adult-onset VSD and suggests that additional research is needed to optimize treatment algorithms for this challenging patient population.

Drug-induced lupus erythematosus (DILE) is a rare, reversible condition caused by prolonged exposure to certain medications. This report describes a case of a 43-year-old female who developed DILE following chronic treatment with lisinopril, an angiotensin-converting enzyme (ACE) inhibitor commonly prescribed for hypertension. The patient presented with systemic lupus erythematosus-like symptoms, including joint pain, fatigue, and a photosensitive rash, without a prior history of autoimmune disease. Laboratory tests revealed positive antinuclear antibodies (ANA) and antihistone antibodies, supporting the diagnosis of DILE. This case underscores the importance of recognizing DILE as a potential side effect of ACE inhibitors, as early diagnosis and drug discontinuation can significantly improve patient outcomes. Further studies are warranted to explore the pathophysiology of ACE inhibitor-induced DILE and to identify risk factors for its development.           

Based on this study, there is high variability within preceptor expectations. 80.6% of respondents ranked “enthusiasm and willingness to learn” as the most important student characteristic/quality. We think it is important to have early conversations with your preceptor to establish their expectations and learn how you can excel in that rotation.