MU-COM Research Day
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Last Updated: 2021-10-22
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MU-COM Research Day is an annual showcase of the the research engagement of the students within the College of Osteopathic Medicine. Content on display are typically poster presentations along with faculty-led discussions of research projects. This event is coordinated by the MU-COM Research Club as well as the Faculty-led Research Club Committee.- Articulos totales
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265
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Trabajos (262)
71.COPD Exacerbations in Nursing Homes: A Retrospective Chart Review
- Title Tesim:
- COPD Exacerbations in Nursing Homes: A Retrospective Chart Review
- Creador:
- Mack, Laramie, Unroe, Kathleen, and Elsener, Luke
- Descripción:
- Introduction: OPTIMISTIC is a project funded by the Centers for Medicaid and Medicare Services (CMS) that is aimed, in part, at the reduction of unnecessary hospitalization of nursing facility residents. Data from the initial phase of the project indicated that 11% of resident potentially avoidable hospitalizations were associated with a diagnosis of COPD. Avoidable hospital transfer of long-term stay nursing home residents carries both a large financial burden and a poor prognosis, making avoidance essential to care. Objective: This retrospective chart review has the goal of analyzing and describing the diagnosis, treatment strategies, and outcomes for nursing home patients treated for an exacerbation of COPD in OPTIMISTIC facilities. Methods: A list of all patients from OPTIMISTIC facilities that billed CMS for the diag-nosis of a COPD Exacerbation from 11/1/2017 to 6/1/2019 was obtained, the top 6 highest billing facilities were selected, and 3 patient charts from each facility were se-lected at random. This yielded 18 individual patient records, with 2 patients having multiple billing episodes within the time period, for a total of 23 episodes. A standard-ized data collection tool was used to collect information from both online electronic medical records and paper charts. The data tool included demographics, patient medical history, COPD staging and treatment, diagnostic data, treatment facts, and out-comes. All data was stored without patient identifiers, under password protection. Results: The mean age of patients was 82 years (n=18), and the percentage of patients suffering from an exacerbation and/or all cause hospitalization within one year of their certification were both 39% (n=7). 70% (n=16) of patients were certified by the provider within 2 days. In 78% (n=18) of cases, patients were able to recover to their prior condition within the facility, while only 9% (n=2) required the patient be transferred to the hospital. Providers ordered inhaled bronchodilators in 96% (n=22) of cases, antibiotics in 70% (n=16), and oral Prednisone in 78% (n=18) of cases. OPTIMISTIC certification criteria were met in 87% (n=20) of cases. Conclusions: Given the disease state, comorbidities, history, and age of this population, many are high-risk COPD patients. This chart review demonstrated efficacy of the OPTIMISTIC care model for in-house recovery of residents in an acute exacerbation of COPD. Patients were diagnosed and treated rapidly in a large majority of cases. Treatment strategies and choices aligned reasonably well with OPTIMISTIC evidence-based treatment protocols. Only one patient was not prescribed an inhaled bronchodilator, and most patients were given some course of oral prednisone, both of which are indicated in the treatment of an acute COPD exacerbation. Results indicated relatively low use of antibiotic therapy, but varied antibiotic usage of multiple classes, supporting the need for continued vigilance in antibiotic stewardship.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- poster
- Fecha de Creacion:
- 11/22/2019
72.The Counter-productive Problem of Overmedication in the United States
- Title Tesim:
- The Counter-productive Problem of Overmedication in the United States
- Creador:
- Gupta, Ansh
- Descripción:
- What is Overmedication? Overmedication is a very broad term with many definitions, each centering around the concept of administering too much medication(s). Though not to the point where it may be considered an overdose, it is still considered excessive/unnecessary and can lead to side-effects. In the context of this presentation, I will be referring to the more specific definition of “over-prescription,” – the concept that a patient is prescribed more medication than is necessary to resolve their condition. Top 5 most overused medications in the US To better understand the problem of overmedication, it may help to focus on some of the top ten most prescribed drug classes in the US. A study in the National Library of Medicine (NLM) focused on drug classes which may warrant closer analyses on their benefits vs. side-effects. It was identified that Proton Pump Inhibitors (PPIs) for indigestion, Levothyroxine for hypothyroidism, Statins, Opioids for chronic pain, and Antidepressants were some of the most frequently prescribed drugs [1]. Submitted as part of the BMS-515 Public Health and US Healthcare System course for MUCOM Research Day.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- Poster
- Palabra clave:
- Overmedication , over-prescription, Levothyroxine, Proton Pump Inhibitors, Statins, and Antidepressants
- Fecha de Creacion:
- 2023
73.Coxiella Burnetii Infection Increases Cyclooxygenase Levels in Alveolar Macrophages
- Title Tesim:
- Coxiella Burnetii Infection Increases Cyclooxygenase Levels in Alveolar Macrophages
- Creador:
- Mulye, Minal and Leeds, Blake
- Descripción:
- Coxiella burnetii is a Gram-negative obligate intracellular pathogen, which spreads via inhalation. Although it initially infects alveolar macrophages, it can cause endocarditis several months to years after infection. This suggests that Coxiella has the ability to survive long-term within the host cells. Our overall goal is to identify how Coxiella achieves this long-term intracellular survival. Previous studies suggest that Coxiella manipulates host lipid metabolism and immune response to establish infection. Our lab has recently shown that Coxiella specifically manipulates metabolism of host lipid storage organelles called lipid droplets (LDs). Further, blocking LD breakdown inhibits bacterial growth suggesting that LD-derived lipids are critical for Coxiella growth. On breakdown, LDs release arachidonic acids, which are converted to prostaglandin E2 (PGE2) by the enzyme cyclooxygenase (COX). PGE2 modulates immune responses during alveolar macrophage infection by other intracellular pathogens like M. tuberculosis, C. pneumoniae to promote bacterial survival. Hence we hypothesize that in Coxiella-infected cells lipid droplet breakdown results in increased PGE2 production to promote bacterial growth. To test this hypothesis, we first analyzed the gene expression of PGE2 synthesis enzyme COX. Compared to uninfected cells, we observed increased cox expression in Coxiella-infected cells. Further, quantitation of total COX enzymatic activity using a fluorescence assay showed increased total COX activity in Coxiella-infected cells. Since COX levels are directly proportional to PGE2 production, our data suggests that Coxiella infection increases PGE2 levels. Ongoing studies are identifying the role of lipid droplets in PGE2 production and the importance of PGE2 during Coxiella infection.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- poster
- Fecha de Creacion:
- 11/9/2018
74.Coxiella burnetii infection upregulates enzyme cycloxygenase-2 gene expression in alveolar macrophages
- Title Tesim:
- Coxiella burnetii infection upregulates enzyme cycloxygenase-2 gene expression in alveolar macrophages
- Creador:
- Mulye, Minal, Kim, Constantine, Shain, Michael, and Wooten, Steven
- Descripción:
- Coxiella burnetii is an obligate intracellular Gram-negative bacterium that causes Q fever in humans. While acute infection manifests as self-limiting flu-like illness, chronic Q fever presents as non-culturable endocarditis, which is fatal if untreated. Although Coxiella spreads via inhalation and initially infects alveolar macrophages, it survives in the host long-term and may spread to the heart and cause endocarditis. The occurrence of Coxiella endocarditis up to 20 years after initial infection suggests that the bacterium persists in the host and subverts several host cell processes to promote infection. Our overall goal is to identify specific host cell pathways that Coxiella manipulates to achieve long-term intracellular survival. Previous studies in Coxiella endocarditis patients reported increased production of the lipid immune mediator prostaglandin E2 (PGE2), which subsequently promoted Coxiella growth. Our preliminary studies in infected alveolar macrophages reveal an increase in PGE2 production, suggesting its importance during Coxiella infection. Hence, we hypothesize that targeting PGE2 production in Coxiella-infected cells prevents bacterial intracellular growth. Since PGE2 production is directly proportional to the expression and activity of the enzyme cyclooxygenases (Cox), we first determined the gene expression of constitutively expressed Cox-1 and infection-induced Cox-2. Our studies show that Coxiella infection increases Cox-2 gene expression and not Cox-1, suggesting the importance of Cox-2-derived PGE2 production in Coxiella-infected cells. Ongoing studies are determining Cox-2 enzymatic activity in infected cells. Future studies will deter-mine the potential of Cox-2 as a therapeutic target to prevent Coxiella's long-term survival and thus treat endocarditis.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- poster
- Fecha de Creacion:
- 11/22/2019
75.Cryoglobulinemic Vasculitis in a Patient with Trismus Pseudocamptodactyly
- Title Tesim:
- Cryoglobulinemic Vasculitis in a Patient with Trismus Pseudocamptodactyly
- Creador:
- Ashack, Kurt, Martin, Anthony, and Aleshaki, Joseph
- Descripción:
- Cryoglobulinemia is a condition where immunoglobulins precipitate at temperatures < 37°C causing damage to blood vessels of the skin, joints, peripheral nervous system, and kidneys. Diagnosis is difficult due to various etiologies and clinical manifestations. We present a challenging case of idiopathic type III cryoglobulinemia. A 33-year-old man with a history of trismus pseudocamptodactyly syndrome (TPS), chronic pain, and polysubstance abuse presented with several days of worsening rash on both feet. The patient noted more restriction in his joints, increased from his baseline restriction due to TPS. Physical exam revealed palpable purpura on the dorsum of both feet. Extensive tests were performed (CBC, CMP, PT and INR, Lupus Anticoagulant (LA), Hepatitis B and C serology, HIV antibody, ANA panel, ANCA panel, serum complement) which were unremarkable. A punch biopsy of the right foot demonstrated epidermal necrosis with vascular thrombosis. The patient was discharged due to improvement of his condition. Two weeks later, the patient was readmitted for worsening pain in his feet. The purpuric lesions were more necrotic compared to his last visit. New petechiae appeared on the ventral forearms. Work-up for lupus, infectious etiologies, and malignancy were negative; however, a cryoglobulin test was positive. A follow-up SPEP revealed elevated polyclonal IgM of 622 mg/dL. A punch biopsy of the new lesions revealed leukocytoclastic vasculitis (LCV), which can be caused by mixed cryoglobulinemia (MC), further supporting the diagnosis. This case highlights the difficulty in making the diagnosis of cryoglobulinemia in a patient with a history of drug abuse and TPS. His clinical presentation was confounded by his inability to localize any particular joint involvement due to chronic pain, his history of polysubstance abuse raising concerns for drugseeking behavior, and his negative hepatitis panel making the diagnosis of MC less likely. Despite this, the patient did meet several classification criteria for cryoglobulinemia, which include: the presence of cryoglobulins, elevated monoclonal IgM, constitutional symptoms, and articular and vascular involvement.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- poster
- Palabra clave:
- Cryoglobulinemia, Cryoglobulinemic vasculitis, trismus pseudocamptodactyly, and Trismus
- Fecha de Creacion:
- 1/1/2016
76.Cryotherapy: Don't freeze out the cardiovascular consequences of cold pain
- Title Tesim:
- Cryotherapy: Don't freeze out the cardiovascular consequences of cold pain
- Creador:
- McDowell, Jasmine, Krause, B., Wilson, Thad, and Addington, Gretchen
- Descripción:
- INTRODUCTION: Cold limb immersion, a form of cryotherapy, can cause cardiovascu-lar changes due to cold-pain induced autonomic reflex. OBJECTIVE: This cryotherapy treatment side-effect has received less attention, and could have direct implications for the physical rehabilitation of individuals who have cardiovascular co-morbidities. METHODS: To test hypotheses related to the pressor effects of limb and surface area of cryotherapy, two common lower limb injury sites (the ankle and knee) were immersed into cold water for 15 min at 1-3°C and then referenced to a standard cold pressor test (CPT). Beat-by-beat arterial blood pressure (finger photoplethysmogra-phy), heart rate (ECG), systemic vascular conductance (SVC; Modelflow), and calf VC (venous occlusion plethysmography) were measured in 14 healthy participants. RESULTS: At 2 min, CPT increased mean arterial pressure (MAP; 21±4 mmHg) to a greater degree than either ankle or leg immersion (15±4 and 15±5 mmHg, respective-ly; P=0.015). SVC and calf VC decreased but were not different across treatments (P=0.713). MAP and SVC were not different from 2 min to 15 min of immersion (P=0.164 and P=0.522), but calf VC decreased further by the end of immersion (3.1±0.5 to 2.8±0.4 and 2.7±3 to 1.7±0.2 units; P=0.028). MAP increases to CPT were similar on CPT day and when CPT followed ankle or leg immersion (27±5 and 23±4 mmHg, respectively; P=0.199). CONCLUSION: These data indicate ankle and leg immersion cause a significant but equivalent increase in arterial blood pressure, but immersion of the hand causes a greater pressor response. Thus, the location but not the precise surface area of immersion of cryotherapy appears to be an important factor. No cold-pain habituation or progressive change of MAP was observed from the initial immersion, but significant decreases in non-immersed calf VC were observed during the duration of cryotherapy. Rehabilitative specialists should consider the effect of these responses when recommending cryotherapy to patients with cardiovascular conditions.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- poster
- Fecha de Creacion:
- 11/20/2019
77.The cytotoxic role of the inhibition of different steps in the PI-3-kinase pathway and acto-myosin cross bridge formation in human metastatic breast cancer cells
- Title Tesim:
- The cytotoxic role of the inhibition of different steps in the PI-3-kinase pathway and acto-myosin cross bridge formation in human metastatic breast cancer cells
- Creador:
- Bhetwal, Bhupal and Thirumeni, Rajashree
- Descripción:
- Introduction: Externally added survival/growth factors are essential for the survival of healthy cells, however cancer cells are believed to be self-sufficient in supporting their auto-proliferation without the need of exogenously added growth factors. The Phospha-tidyl-Inositol-3-kinase (PI-3-kinase) pathway is crucial in cell survival. Also, cancer cells exhibit enhanced potential to metastasize via increased acto-myosin cross bridges formation which requires increased Ca2+ influx via cell surface voltage-gated Ca2+ channels leading to activation of myosin light chain kinase (MLCK). The MLCK then phosphorylates myosin and forms acto-myosin cross-bridges. The role of MLCK, PI-3-kinase, and calcium channel in cancer cell growth has not been extensively tested. In this study, we tested the individual effects of blocking cell survival pathway (PI-3 kinase), voltage-gated Ca2+ channels, and MLCK on human metastatic breast cancer cell line (MCF-7) survival. Hypothesis: We hypothesized that all three drugs would inhibit cell proliferation. Aims: Our aim was to firstly test if these drugs had any effect at all on cancer cell growth. Secondly, it was to test each drug at different concentrations and see which concentration had the most effect on cell death. Methods: PI-3-kianse inhibitor (Wortmannin); MLCK inhibitor (ML-7), and lastly, a calcium channel inhibitor (nifedipine) were used. 1% Bitter melon extract (BME) was also tested as this was found to inhibit MCF-cell growth in our lab by earlier investigators. Cells were thawed, mixed with a medium that contained all essential nutrients for cell growth (DMEM + fetal bovine serum), and then were added onto 96-well plates and allowed to grow for 48 hours. We incorporated control plates (no drug), plates with drugs at different concentrations, a plate with the compound the drug was originally dissolved in (DMSO or ethanol), and a plate with 1% BME (bitter melon extract). The plates were analyzed under a microscope and cell viability was measured using MTT assays. Results and Discussion: All three drugs inhibited cell growth in a dose-dependent manner. The observable differences between the different drugs were the concentrations at which they were effective. Images of each plate were taken and correlated with the MTT assay graphs. Acknowledgement: The research was partially supported by the Research and Honors and Awards Committees at MU-COM
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- poster
- Fecha de Creacion:
- 11/22/2019
78.Developing an in vitro model of CKD-MBD induced αKlotho suppression
- Title Tesim:
- Developing an in vitro model of CKD-MBD induced αKlotho suppression
- Creador:
- Tobin, Kirby, Hum, Julia, Oberhelman, Forrest, LaFave, Nicole, Young, Collin, and Waite, Timothy
- Descripción:
- Chronic Kidney Disease (CKD) affects approximately 1 in 10 Americans. Diabetic nephropathy is also associated with the development of chronic kidney disease-mineral bone disorder (CKD-MBD). CKD-MBD disrupts the normal bone-kidney endocrine axis responsible for regulating mineral metabolism, and hyperphosphatemia develops in late stage disease. Important clinical hallmarks of the CKD-MBD progression include elevated bioactive bone derived Fibroblast growth factor-23 (FGF23) and suppression of FGF23’s co-receptor, αKlotho (αKL). In healthy individuals the hormone FGF23, primarily produced by bone, and αKL aid in maintaining normal phosphate and vitamin D homeostasis. It is currently unknown what drives the suppression of αKL expression, however increasing αKL expression in CKD-MBD models is being investigated as a novel therapeutic. Our study sought to develop a novel in vitro model of one of the clinical hallmarks of the progression of CKD-MBD, αKL suppression, to investigate both possible stimuli of its repression and downstream signaling events. The Human Embryonic Kidney (HEK) cell line was used to determine if changes in fluid shear stress, similar to those that occur in diabetic nephropathy, could lead to reduced αKL expression. HEK cells were plated and exposed to oscillatory fluid shear stress (OFSS) for intervals between 0-60 min to examine protein expression or 0-2 hours to assess gene expression. HEK cells were sensitive to mechanical stimulation as pathways including increased ERK phosphorylation occurred in response to OFSS. In response to longer bouts of OFSS αKL expression was reduced. Dramatic changes in fluid shear stress may serve as a stimulus for reduced αKL expression in CKD-MBD. Further studies are underway to investigate downstream signaling events related to αKL suppression. Understanding both the stimuli of αKL suppression and related downstream signaling events could provide novel therapeutic targets for the treatment of CKD-MBD.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- poster
- Fecha de Creacion:
- 11/22/2019
79.Developing an In Vitro Model of CKD-MBD Induced αKlotho Suppression
- Title Tesim:
- Developing an In Vitro Model of CKD-MBD Induced αKlotho Suppression
- Creador:
- Tobin, Kirby, Hum, Julia, Oberhelman, Forrest, and Waite, Timothy
- Descripción:
- Chronic Kidney Disease (CKD) affects approximately 1 in 10 Americans. Diabetic nephropathy is also associated with the development of chronic kidney disease-mineral bone disorder (CKD-MBD). CKD-MBD disrupts the normal bone-kidney endocrine axis responsible for regulating mineral metabolism, and hyperphosphatemia develops in late stage disease. Important clinical hallmarks of the CKD-MBD progression include elevated bioactive Fibroblast growth factor-23 (FGF23) and suppression of FGF23’s co-receptor, αKlotho (αKL). In healthy individuals the hormone FGF23, primarily produced by bone, and aKL aid in maintaining normal phosphate and vitamin D homeostasis. It is currently unknown what drives the suppression of αKL expression, however increasing αKL expression in CKD-MBD models is being investigated as a novel therapeutic. Our study sought to develop a novel in vitro model of one of the clinical hallmarks of the progression of CKD-MBD, αKL suppression, to investigate both possible stimuli of its repression and downstream signaling events. The Human Embryonic Kidney (HEK) cell line was used to determine if changes in fluid shear stress, similar to those that occur in diabetic nephropathy, could lead to reduced αKL expression. HEK cells were plated and exposed to oscillatory fluid shear stress (OFSS) for intervals between 0-60 min to examine protein expression or 0-2 hours to assess gene expression. HEK cells were sensitive to mechanical stimulation as pathways including increased ERK phosphorylation occurred in response to OFSS. In response to longer bouts of OFSS αKL expression was significantly (p<0.05) reduced. Dramatic changes in fluid shear stress may serve as a stimulus for reduced αKL expression in CKD-MBD. Further studies are underway to investigate downstream signaling events related to αKL suppression. Understanding both the stimuli of αKL suppression and related downstream signaling events could provide novel therapeutic targets for the treatment of CKD-MBD.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- poster
- Fecha de Creacion:
- 11/9/2018
80.Development of a Registry to Identify Patent Ductus Arteriosus Treatment Patterns in Preterm Infants at Peyton Manning Children’s Hospital
- Title Tesim:
- Development of a Registry to Identify Patent Ductus Arteriosus Treatment Patterns in Preterm Infants at Peyton Manning Children’s Hospital
- Creador:
- Tauscher, Markus , Segar, Rachel , and Tauscher, Zenaida
- Related Url Tesim:
- Audio presentation: https://marian.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=274268cc-42b5-474b-98f1-adf70123528b
- Descripción:
- Background: A patent ductus arteriosus (PDA) is a common diagnosis among extremely preterm infants. Unfortunately, this left to right shunt may result in significant complications including pulmonary edema, pulmonary hemorrhage, bronchopulmonary dysplasia, as well as intraventricular hemorrhage, and necrotizing enterocolitis. Notably, there is no consensus on treatment for a PDA. As such, the diagnosis and treatment of a PDA have varied considerably between practitioners and institutions. Problem: In the neonatal intensive care unit (NICU) at Peyton Manning Children’s Hospital (PMCH), there are no standardized criteria for screening for a PDA, echocardiographic description of a PDA or treatment of a PDA. Ordering confirmatory echocardiography (ECHO) for a suspected PDA and treatment is dependent on the attending neonatologist. Aim: To address this knowledge gap, a retrospective, observational cohort study was designed to evaluate the clinical circumstances leading to an echocardiographic evaluation for a PDA, to collect information on how a PDA is described echocardiographically, the management of the PDA, and the impact on morbidity and mortality of extremely preterm infants.
- Declaración de derechos:
- http://rightsstatements.org/vocab/InC/1.0/
- Idioma:
- English
- Tipo de recurso:
- Poster
- Palabra clave:
- Preterm Infants, Patent Ductus Arteriosus , Peyton Manning Children’s Hospital, and Treatment Patterns
- Fecha de Creacion:
- 2021