Undergraduate Medical Education Works
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Item Gender-Affirming OB/GYN Care: A Case Study of IUD Placement in a Non-Binary Individual(2024-03-27) Vogel, Katherine; McGuire, Evelyn; Karki, Savin; Salter, Lucy; Henderson, RicItem Impacts of Estrogen Receptor Alpha (ERα) Deficiency on Dynamics of the Ovarian Immune Microenvironment(2024-07-31) Salter, Lucy; Sessions, Katherine; Krementsov, Dimitry; Brodeur, TiaItem The effect of maternal blood transfusion history on alloimmunized pregnancies(2025-01-27) Arkerson, Brittany; Fazeh, Aghajani; McGuire, Evelyn; Modrall, Katherine; Salter, Lucy; Shanks, Anthony; Mustafa, HibaItem Resolving Discrepancies in Mayo Clinic’s CKD Patient Registry & Aiding in Novel CKD Program Implementation for Clinical Use(2022-08-05) Salter, Lucy; Moran-Melendez, Andrea; Vaughan, Lisa; Albright, Robert; MAnohar, Sandhya; Zoghby, Ziad; Kattah, Andrea; Boehmer, KaseyItem Comparative Analysis of Postoperative Outcomes at 6 Weeks and 6 Months: Basilar Thumb Reconstruction with Trapezium Excision and FiberLock InternalBrace Reconstruction with Tenodesis versus Thumb Trapeziectomy with Ligament Reconstruction and Tendon Interposition(2024-06-21) Malik, Hanna; Ratigan, Connor; Yocum, Derek; Mencias, Adelbert; Fuller, SamBackground: Basilar Thumb Reconstruction (BTR) is a surgical procedure for the treatment of basilar thumb arthritis at the first carpometacarpal (CMC) joint of the thumb. There are a variety of surgical techniques that can be used in this procedure; however, they vary in post-operative outcomes of pain, function, recovery time, and strength. Optimizing surgical techniques in BTR is important for long-term patient outcomes, as the thumb is central for many activities of daily living. Research regarding the post-operative outcomes of BTR surgery with newer techniques, such as those with medical device implants, is crucial in determining the trajectory of this growing field. Hypothesis: FiberLock suture suspenionplasty will yield superior post-operative outcomes 6 weeks following BTR in terms of patient-reported outcome measures (PROMIS), functional disability (QuickDASH), and pain levels (painVAS) compared to trapexiectomy with ligament reconstruction and tendon interposition (LTRI) in patients with thumb CMC joint osteoarthritis. Methods: Retrospective data was collected on 77 patients with thumb carpometacarpal (CMC) arthritis who underwent trapeziectomy with LRTI or Arthrex FiberLockTM Suspension Implants (Arthrex, Naples, FL, USA) InternalBrace suspensionplasty with trapezium excision and side-to-side flexor carpi radialis tendon transfer. There were 39 LRTI and 39 FiberLock Internal Brace suspensionplasty procedures. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, and Patient-Reported Outcomes Measurement Information System (PROMIS) v1.2 Upper Extremity (UE) item bank. Patient demographic data was also recorded. Results: The PERMANOVA test revealed a significant difference in multivariate centroids between the groups (p < 0.01). Approximately 31.29% of the variation in the dataset was explained by the grouping variable. However, post-hoc pairwise tests demonstrated no significant (All p > 0.05) differences between groups for (VAS Pain 24 Hours, VAS Pain When Resting, VAS Pain When Active, PROMIS Upper Extremity, and Quick DASH). Summary Points: Our analysis demonstrated LRTI patient may have more consistent outcomes 6-weeks after surgery compared to the newer FiberLock procedure. However, it is promising that no significant differences were seen between the patient outcome surveys of the two groups. Future research on long-term outcomes will be beneficial in comparing the effects of this new surgical technique.Item Ulnar Collateral Ligament Injuries in Overhead Throwers: An All Too Familiar Problem(2023-04-26) Callahan, KyleThe ulnar collateral ligament (UCL) is the main stabilizer of valgus stress put on the elbow during overhead throwing movements and thus a common site of tearing. Traditional treatment includes Tommy John surgery, with as long as a 17 months return to play period (4). In professional athletes who require to be healthy to get paid, return to play time is of the essence, so what alternative options are there for those who tear their UCL? This curiosity led to the development of the question: In high level baseball players (HS and above) with UCL tears, is platelet-rich plasma (PRP) injection as effective and possess a quicker return to competition time compared to conventional TJ surgery? After a dive into PRP primary literature, which was scarce considering the novelty of the therapy, PRP has been shown to be highly effective in promoting a quicker return to play in overhead throwing athletes who have experienced partial UCL tears, compared to those undergoing traditional TJ surgery. However, for those who have experienced more severe tears (complete), PRP is likely not an effective option.Item Lessons Learned and Opportunities for CBEMS Growth Following the COVID-19 Pandemic(The Journal of Collegiate Emergency Medical Services, 2022-11-30) Balaji, Adhitya; Robishaw-Denton, JacobItem Complications and Outcomes Associated with Two-Stage Treatment of Periprosthetic Total Knee Infection(2024-04-19) Thomas, Jacob; Ziemba-Davis, Mary; Buller, Leonard T.; Meneghini, R. MichaelBackground: Chronic periprosthetic joint infection (PJI) has been traditionally treated with two-stage revision. However, single-stage treatment is gaining popularity based on claims of decreased morbidity and mortality. This study sought to evaluate whether two-stage treatment for chronic knee PJI is associated with high morbidity and complication rates compared to existing literature. Methods: Prospectively collected data on all two-stage knee revisions were retrospectively reviewed (n=97). Modern perioperative optimization protocols were implemented during the interstage and post-reimplantation periods. Surgical complications were quantified for interstage and post-reimplantation periods. Chi-squared tests compared current findings to published data. Results: Patient sex and age were equivalent, with more current smokers in the present study (P=.001) and more renal failure (P=.002) in the comparison study. Infection complexity in the current study is indicated by 84% late chronic infections in compromised (McPherson) hosts (70%) with 14% polymicrobial infections (unknown for comparison). One percent of cases in the current study did not undergo component reimplantation compared to 8.2% in the comparison study (P=.015). There were no differences in interstage and post-reimplantation septic surgeries (P=.566). Within a year of reimplantation, 9% versus 29% underwent septic reoperation (P=.0002). Using a proposed system from the comparison study penalizing additional operations required to eradicate infection, treatment success rates at minimum one-year follow-up were 56% (current study) and 51% (comparison study) (P=.412). Without these penalties, treatment success in the current study was 64% (unknown for comparison). All-cause mortality rates were the same in both samples (13.4%); however, 9/13 deaths in the current study were unrelated to PJI (unknown for comparison). No patients in the current sample died within the first postoperative year compared to 6.7% in the comparison (P=.024). Conclusion: Study data suggest morbidity attributed to two-stage treatment for PJI reflects the inherent complexity of this patient group, and not the two-stage treatment itself.Item Acute Heart Failure in the Setting of Post-Covid MIS-C: A Case Report(2023-03-24) Luster, Taylor; Sloat, Brittany; Mederos, Alexa; Karam, Marie; Pavlik, Lauren; Duncan, FrancescaIntroduction: Multi-inflammatory Syndrome in Children (MIS-C) has emerged as a rare, but severe complication of SARS-CoV-2 infection. Patients present with persistent fever, abdominal pain, diarrhea, vomiting, rash, mucocutaneous lesions, and in severe cases, shock. The diagnostic criteria are age < 21, fever, laboratory evidence of inflammation, multi-organ involvement, and a positive COVID-19 test or known exposure 4 weeks prior to symptoms onset. Case Description: A 17-year-old female with a history of prior COVID-19 infection presented complaining of chest pain, shortness of breath, headache, and fevers with a Tmax of 105F for 4 days. The patient was hypotensive, tachycardic, tachypneic, and hypoxic. Pertinent labs included: Na 126, BUN 48, Creatinine 2.1, ALT 62, AST 86, WBC 27.4, Hg 10.5, Troponin 0.96, Lactate 3.3, CRP 60, ESR 85, Procalcitonin 75, D-dimer 2.02, Fibrinogen >1000, COVID PCR negative, and COVID Ig-G reactive. CT chest was notable for bibasilar pulmonary opacites, cardiomegaly, and bilateral pleural effusions. Echocardiogram showed left ventricular ejection fraction of 21% and global hypokinesis. She was ultimately intubated due to respiratory failure and started on milrinone and vasopressors. She was treated with IVIG, aspirin, and methylprednisolone for MIS-C. She clinically improved and repeat echo showed an improved EF of 57% and was discharged after 10 days with a prolonged prednisone taper. Clinical Significance: The incidence of MIS-C is 316 per 1 million pediatric SARS-CoV-2 infections. This case demonstrates need for increased awareness of potential acute cardiac failure in adolescents with a recent history of COVID-19 infection, elevated inflammatory markers, and signs of multi-organ failure so that IVIG, aspirin and corticosteroids can be started immediately to avoid progression of MIS-C into acute cardiac failure. Conclusion: Pediatric presentation of SARS-CoV-2 infection can be mild, but there is a subset of patients that have been reported to develop MIS-C, a more severe post viral syndrome.Item Complications and Outcomes Associated with Two-Stage Treatment of Periprosthetic Total Knee Infection(2022-07-22) Thomas, Jacob; Ziemba-Davis, Mary; Meneghini, R. MichaelBackground and Hypothesis: Periprosthetic joint infection (PJI) is treated with implant resection, debridement, and component reimplantation after infection eradication. Treatment consists of either a single surgery or two-stage surgery with intravenous antibiotic therapy between stages. We replicated a recent study which concluded two-stage treatment is associated with high morbidity, hypothesizing that complication rates would be similar, but that morbidity is not always conclusively a consequence of two-stage treatment for PJI Project Methods: Prospectively documented data on all primary and revision knees undergoing two-stage treatment for PJI by a single surgeon were retrospectively reviewed. Surgical complications were quantified for the interstage and post-reimplantation periods. Chi-squared tests were used to compare current findings to published findings. Results: Patient demographics and comorbidities were equivalent in the two studies (p ≥ .137). More complex infections characterized the current study as evidenced by significantly more polymicrobial infections (p < .001) and greater use of static spacers due to bone loss (p = .002). Nonetheless, only 1.5% of cases in the current study did not undergo component reimplantation compared to 7.8% in the comparison study (p = .129). There were no differences in the number of additional interstage and post-reimplantation septic surgeries (p ≥ .492). Using a proposed system which penalizes additional operations required to eradicate infection, treatment success rates at minimum one year follow-up were 64% and 71%, respectively (p = .473). Without these penalties, treatment success in the current study was 95.6% (equivalent proportion not available for comparison study). All-cause mortality was statistically equivalent in the two studies (15.6 versus 7.6%, p = .144) but no deaths from PJI were observed in the current study (unknown for comparison study). Potential Impact: Study findings suggest that morbidity attributed to two-stage treatment reflect the inherent complexity of this patient group, and not the two-stage treatment itself.