• Comparison of Occipito-atlanto-axial Parameters on Computed Tomography in Pediatric Trauma Patients

      Calhoun, Matthew; The University of Arizona College of Medicine – Phoenix; Connell, Mary (The University of Arizona., 2019)
      Spinal cord injury without radiographic abnormality is a prevalent issue within the pediatric population. Children under the age of 10 are prone to sustaining injury at C1 to C4 because their biomechanical fulcrum exists between C2 and C3. The incidence of spinal cord injury in pediatric population has been estimated to be 4.6 per million per year or 1-2 % of all pediatric trauma cases. There may be subtle findings on computed tomography (CT) that may be able to identify occult cervical spine injury in pediatric trauma patients, which would be evident on magnetic resonance imaging (MRI). This study aims to measure various dimensions of the atlantoaxial and atlantooccipital joints in the pediatric cervical spine in patients with normal spines to detect subtle irregularities on CT scans to warrant further work up with an MRI in trauma patients. Additionally, having an accurate diagnosis will help guide the appropriate type and duration of treatment, which can range from conservative treatment with immobilization to surgery.
    • C-Terminally Truncated Apolipoprotein A1 Glutamate Residue 243 Is a Biomarker for Oxidative Stress in Coronary Artery Disease and Chronic Kidney Disease

      Wilson, Zachary; The University of Arizona College of Medicine – Phoenix; Breberda, Christian S. (The University of Arizona., 2019)
      High density lipoprotein (HDL) oxidation is a potential biomarker for coronary artery disease (CAD) severity. Methionine sulfoxidation, tyrosine chlorination and C-terminal truncation are Apo A- I modifications that inactivate HDL and lead to pro-oxidant action. We hypothesize that C-terminal truncation of apolipoprotein A1 glutamate residue 243 (Apo A-I Des-Q243) is a byproduct of a protease, such as a matrix metalloprotease (MMP), and it is associated with the presence and severity of coronary artery disease and chronic kidney disease (CKD). We enrolled 103 patients presenting for evaluation of chest pain in this cross-sectional study at Maricopa Medical Center. Plasma and serum samples were collected, processed, and transferred to Arizona State University (ASU) Biodesign Institute for high pressure liquid chromatography-mass spectrometry (HPLC-MS). A statistical analysis was conducted with a spearman’s coefficient, two-tailed linear regression and multivariate analysis of the relative fractional abundance (RFA) of Apo A-I Des-Q243 and clinical variables. Multivariate analysis revealed significantly reduced levels of Apo A-I Des-Q243 in the presence of male gender (-1.5%, P=0.035), atrial fibrillation (-2.8%, P=0.04), and ACEi/ARB use (-2.4%, P=0.001). Additionally, a diagnosis of CKD (2.3%, P=0.037) and the presence of four (9.6%, P=0.005) or five (4.7%, P=0.045) coronary stents, regardless of vessel location, were associated with significantly increased levels of Apo A-I Des-Q243. American Indian/Alaskan race as compared to Caucasian race (Plasma -5.8%, 95% CI -9.9- -1.8%, P=0.005; Serum -4.6%, 95% CI -8.5- -0.8%, P=0.02), and the eGFR (Plasma ρ=-0.024, P=0.014, Serum ρ=-0.291, P=0.003) only reached significance in the linear regression and spearman’s correlation analysis respectively. Apo A-I Des-Q243 is elevated in patients with multiple coronary stents, and thus may be contributing to vascular inflammation and plaque formation. Furthermore, Apo A-I Des-Q243 is elevated in CKD and is directly correlated with its severity as determined by eGFR. These findings highlight the renin-aldosterone system’s (RAS) role in HDL oxidation and the anti-oxidant action of ACEi/ARBs. Apo A-I Des-Q243 appears to be an important link between CAD and CKD and is a promising biomarker that warrants further study.
    • Does triptolide alter c-Myc expression through regulation of its associated transcriptional factors and coactivators?

      Cao, Thanh; The University of Arizona College of Medicine – Phoenix; Han, Haiyong (The University of Arizona., 2019)
      In this study we investigated whether triptolide regulates c-Myc expression by inhibiting FBP1 protein expression at the transcription and/or protein level. We performed an RNA sequence to determine global regulation of transcriptome in response to triptolide treatment. In addition, we determined the effects of triptolide on c-Myc, FBP1 and FIR protein expression. We found that 100nM of triptolide inhibited gene expression of c-Myc, FBP1, FIR and XBP. This finding is consistent with a decrease in protein expression of c-Myc and FIR. These finding suggest that triptolide may inhibit FBP1 ability to bind with XBP.
    • The Long Term Efficacy of a Behavioral Based Diabetes Prevention Program for High Risk Hispanic Youth

      Wright, Mia; The University of Arizona College of Medicine – Phoenix; Lee, Maurice (The University of Arizona., 2019)
      There is little known about the long term efficacy of diabetes prevention programs in adolescents targeting high risk youth. In this study a chart review was performed to recruit 21 adolescents from the intervention arm and 9 from the control. The HbA1c, BMI% and BP were measured and they all took a health behavior questionnaire. The results varied but the data suggest that there is not an overall decrease in diabetes risk as there was no statistically significant difference in the A1c or BMI.
    • Outcomes after massive honeybee envenomation in patients with comorbid conditions during hospital admission: a retrospective review

      Zelic, Maximilian; The University of Arizona College of Medicine – Phoenix; Ruha, Michelle (The University of Arizona., 2019)
      This study’s aim was to discover the outcomes associated with massive honeybee envenomation. Additionally, we wanted to observe what trends might be seen with regard to outcomes in patients with comorbidities and those without. Honeybees belong to the insect family of Hymenoptera, which includes wasps, yellow jackets and hornets. Hymenoptera are responsible for more deaths than any other venomous insects and pose a risk to the public due to the emergence of well-established populations of Africanized honeybees. These honeybees are prevalent in southwestern states such as Arizona. Africanized bees are more aggressive and take less to provoke stings than non-hybridized bees, and mass envenomations can cause fatal accidents. This study was a retrospective review of patient charts based on ICD-9 and ICD-10 records indicating massive honeybee envenomation and screened to include only patients meeting our inclusion criteria of ≥ 50 stings over a 10 year period at Banner – University Medical Center Phoenix. 25 total patients were included and epidemiological, clinical, and therapeutic data were obtained and compared for noticeable trends in the data with regard to demographics and comorbidities. The 25 patients ranged in age from 16 to 82 years old. Total number of stings varied from an estimated 50 stings, to over 1000. The majority of patients were estimated to have been stung by between 100 to 500 bees representing thirteen patients (52%). Four patients (16%) had a history of CAD, fourteen patients had hypertension (56%), nine patients had diabetes (36%), and one patient had asthma. In terms of outcomes, five patients (20%) required intubation for airway management, two patients were dialyzed (8%), and the average length of stay was 84.2 hours over the course of hospital admission. Our results showed that there was no obvious trend in the outcomes of patients with and without CAD, asthma, hypertension, and diabetes. Significant trends were primarily seen in the total number of stings sustained. In patients with a greater number of stings, the total length of stay increased dramatically. Number of stings also seemed to indicate a greater risk of requiring intubation as well. Finally, creatine kinase levels were also significantly elevated in patients with a higher sting count, supporting prior work done regarding the effect of mass envenomations with resulting rhabdomyolysis. This research supports that fact that ultimately the biggest determinant of a patient’s clinical course is the number of stings that they present with. It seems safe to assume that a mass envenomation on the scale of hundreds to thousands of stings will greatly increase the chance that this particular patient is going to have significant rhabdomyolysis, be at greater risk of requiring advanced airway measures such as intubation, and be admitted to the hospital for a longer period. Future work would be enhanced by implementing a multicenter review to increase the power of the study to allow for statistical comparisons to be made, creating an opportunity to delineate potential differences in outcomes based on comorbid conditions.
    • Effect of Donor Demographics on Transfusion Recipient Outcomes

      Asprer, Jeanine Elaine; The University of Arizona College of Medicine – Phoenix; Lifshitz, Jonathan (The University of Arizona., 2019)
      Over 21M units of blood are transfused every year, making blood transfusion one of the most common medical interventions in the US. It can be lifesaving, but like many medical interventions, it is not without risks. Thus, most of transfusion research has focused on making the process safer and more accessible. Recent developments in stem cell science – where the transfusion of young blood was shown to reverse stem cell aging and improve physiological function in older mice and conversely, the transfusion of old blood was shown to accelerate stem cell aging and worsen physiological function in younger mice – raise important questions regarding the content of blood being transfused and its associated risks and/or benefits. The purpose of this study is to determine if donor demographics such as age and sex affect patient outcomes. Our hypothesis is that patients receiving blood from younger donors of the same sex have better over-all survival and shorter hospital and ICU stays.
    • Does Animal Assisted Therapy (AAT) have an effect on mood in United States Veterans?

      Baumann, Alysa; The University of Arizona College of Medicine – Phoenix; Nelson, Erin (The University of Arizona., 2019)
      Research has shown benefit for United States veterans with service dogs and emotional support animals. However, the literature is lacking in research on the beneficial effects and impact of therapy animals specifically on the disabled veteran population. This pilot study explored the effects of a single therapy dog on various aspects of mood, including depression and anxiety, in disabled veterans by incorporating five weeks of thirty-minute therapy sessions to a group of eight veterans. Although this was a small sample population, we concluded that five weeks of consecutive animal assisted therapy resulted in a general decrease in anxiety and depression, and an overall positive increase in mood as evidenced by Beck Anxiety Inventory, Beck Depression Inventory, and Trauma Symptom Inventory scores. Further large-scale studies will need to be conducted with a greater number of participants to help support the data in this study.
    • A Systematic Review of Physician-Patient Interactions and the Effect of Health Care Provider Bias and Knowledge on Adolescent Contraception Counseling in Developing Countries and Comprehensive Review: Contraceptive Use and Impact of Physician Counseling for Adolescent Patients of Method Choices and Side Effects in Developing Countries

      Cooke, Alexandra; The University of Arizona College of Medicine – Phoenix; Beyda, David (The University of Arizona., 2019)
      Unmet need for contraceptives in developing countries remains a social and health problem and adolescents are more likely to struggle in starting long-acting contraceptive methods, often due to side effect or other concerns. This study aimed to analyze the biases in the provider-patient relationship and counselling practices for adolescent patients in developing countries. Attention was placed on patient’s preferred method, cultural and moral biases, knowledge gaps of patient and providers, side effect knowledge, and attitudes impacting the relationship upon counseling quality and likelihood of contraceptive use. Systematic review of articles with MeSH terms “developing countries,” “contraception,” “adolescents,” and other search terms yielded 6745 articles; 14 articles were chosen for further review. Findings highlight negative impacts of providers’ ethical concerns and knowledge gaps when addressing method use and side effects. Low knowledge base by providers of varying skill level also highlight a need for improved training on family planning methods.
    • Confocal Microscopy Provides a Rapid Intraoperative Histological Assessment of Brain Neoplasms: Experience with 106 Cases

      Carotenuto, Alessandro; The University of Arizona College of Medicine – Phoenix; Preul, Mark C. (The University of Arizona., 2019)
      Frozen section histological analysis is the mainstay for intra-procedural tissue diagnosis during resection of intracranial neoplasms and for evaluating tumor margins. However, frozen sections are time-consuming and sometimes inaccurate. This study describes potential advantages of CSM imaging of fresh human brain tumor tissues labeled various fluorophores within the neurosurgical operating room facility.
    • Evaluation of the Effects of the MOVE+ vs STAND+ Interventions in the Workplace on Snacking

      Cook, Arianna; The University of Arizona College of Medicine – Phoenix; Buman, Matthew (The University of Arizona., 2019)
      Snacking has been identified as a dietary pattern that could contribute to the prevalence of overweight and obesity. Snacking patterns can be influenced by the environment such as the workplace. The purpose of this study is to determine the effect of workplace sedentary interventions on diet, more specifically snacking, and to give more information on the nutritional value of snacking.
    • Changes in Body Fat Phenotype After Four-Month Walking Interventions

      Panchanathan, Roshan; The University of Arizona College of Medicine – Phoenix; Angadi, Siddharta (The University of Arizona., 2019)
      Walking is an excellent health-promoting activity for obese, sedentary individuals. Visceral fat is linked to cardiovascular disease and mortality. We hypothesized that walking (steps/day) would decrease visceral adiposity and improve laboratory markers of cardiometabolic health in a dose-dependent manner. In the primary study, 79 sedentary, overweight subjects (77% female, 65% Caucasian) were enrolled in a 2x2 factorial randomized controlled walking intervention, with steps measured using a wearable Fitbit fitness tracking device. Participants underwent dual x-ray energy absorptiometry and basic cardiometabolic laboratory measurements (glucose, insulin, total cholesterol, HDL, LDL, triglycerides) before and after the intervention. Lean mass increased from 49.9 ± 9.5 to 50.3 ± 9.4 (p=0.05). No significant changes were observed in any of the cardiometabolic outcomes or localization of fat. The change in steps had no correlation with weight, visceral fat, lean mass, and VO2 peak, refuting the original hypothesis. When analyzing common laboratory markers and demographic characteristics, there were no significant predictors for visceral or total fat mass change, with significant heterogeneity of change in the group. Our study supports the likely contribution of genetic and environmental factors to the physical and laboratory changes seen following a walking intervention in sedentary and insufficiently active overweight people.
    • Additional Hearing Screenings in Pediatrics: Does Earlier, More Consistent Screening Make a Difference?

      Loeb, Sophie; The University of Arizona College of Medicine – Phoenix; Samaddar, Kristen (The University of Arizona., 2019)
      Phoenix Children’s Hospital has implemented a program, following the guidelines set by the Ear Foundation, to do annual hearing screenings from birth to school age. This is in contrast to the recommendations by Bright Futures, which state that screening should be done at birth and then annually after the child has begun kindergarten. This study may help determine the incidence of failed hearing screenings and frequency with which failed screenings translate to an intervention, as well as drive clinical decisions on the frequency/number of screenings at well-child checks.
    • Systematic Review of Stigmas Present against Disabled Children Globally and How These Stigmas Vary across Regions and Population and Comprehensive Review of the Perceptions and Attitudes that Disabled Children Face Globally

      Pusapati, Nithin; The University of Arizona College of Medicine – Phoenix; Beyda, David (The University of Arizona., 2019)
      Current literature shows that disabled individuals are vulnerable compared to their abled body counterparts in a variety of measures, disability varies across regions and cultures and that attitudes toward these disabilities may also vary globally. Literature searches using keyword searches were done based on search strings of “childhood disability” with other phrases. Outcome variables included region, population studied, a general description of the attitudes, a broader category into which the type of attitude falls and whether or not there were persistent negative attitudes toward disability. Meta analyses were done for outcomes. An initial 114 articles were screened to be relevant to the topic. 15 articles had data extracted. Descriptive results demonstrated that cultural and religious norms are associated with negative attitudes toward disability. Meta analyses did not demonstrate any statistical significance between the cultural, religious or regional factors in the likelihood of having negative attitudes toward disability. The association between religion, culture and region and the likelihood of having negative attitudes was not statistically significant. The presence of negative attitudes on the basis of culturally or religiously held beliefs, globally, does appear to exist on review of the literature.
    • The Effect of Radiated vs Non-Irradiated Blood Transfusions on Extracellular Potassium Levels in Infants Undergoing Craniosynostosis Repair

      Dunn, Tyler; The University of Arizona College of Medicine – Phoenix; Singhal, Raj (The University of Arizona., 2019)
      Transfusion Associated Graft Versus Host Disease (TA-GVHD), a risk of blood transfusions, has a mortality rate > 90%. This results when viable donor T-lymphocytes within the transfused product proliferate and attack host tissue. The risk is reduced with irradiation of blood prior to transfusion. The downside to irradiating cellular blood products is that irradiation also affects other cellular components in the blood product causing the level of extracellular potassium to rise due to hemolysis of the red blood cells. The rapid infusion of high potassium blood products has been associated with fatal cardiac arrhythmias. This study evaluated the effect of irradiated versus non-irradiated blood transfusions on extracellular potassium levels if washing irradiated blood prior to transfusion results in less of a change in extracellular potassium.
    • Willingness to Receive HPV Vaccine from Community Pharmacists: Exploring the Perspectives of Rural Caregivers of HPV Vaccine Age Eligible Children

      Dominick, Lauren; The University of Arizona College of Medicine – Phoenix; Koskan, Alexis (The University of Arizona., 2019)
      This study explores the perspectives of caregivers of HPV vaccine age-eligible children living in rural Arizona – in terms of having their child vaccinated by a community retail pharmacist.
    • Investigating the Role of p53 in Herpes Simplex Virus - 1 Replication

      McMahon, Savanah; The University of Arizona College of Medicine – Phoenix; Boehmer, Paul E. (The University of Arizona., 2019)
      Herpes simplex virus 1 (HSV-1) is a common human virus that can cause a variety of pathologies, including oral lesions and invariably fatal encephalitis. As there is currently no cure for HSV-1 infection, worldwide morbidity and mortality rates remain high. HSV-1 replication is under intricate control by both viral and cellular factors that dictate whether the virus undergoes productive lytic replication or enters a state of latency during which there is decreased viral gene expression and virus production. The intricate mechanisms that determine the fate of the virus are not completely understood. p53, the well-known tumor suppressor gene, is involved in various cellular responses to stress, such as viral infection. We hypothesized that p53 plays a role in the establishment of HSV-1 latency by negatively regulating HSV-1 replication through repression of viral gene expression via the ATM/ATR damage response pathway leading to expression of p53 and regulation of gene expression via p53 response elements (RE). Viral yields were determined for HSV-1 strain KOS grown on HCT116 wild-type (p53 +/+) and HCT116 p53-deficient (p53 -/-) cells at a multiplicity of infection (MOI) of 1 and at 72 hours post-infection, with the prediction that the viral titer would be higher for the virus derived from the HCT116 p53-deficient cells. Our results demonstrate that there is no significant difference in HSV-1 titer between p53-deficient cells and wildtype cells under these conditions. This suggests that p53 does not play a vital role in promoting HSV-1 latency overall; rather, p53 may exert both positive and negative effects on HSV-1 replication at varying points in time without favoring one cycle over another. Future research, such as determining viral yield harvested from cells in which the levels of p53 have been increased by both overexpression and the use of pharmacological agents to stabilize endogenous p53, should be conducted to further elucidate these complexities.
    • Egr3-­/-­ Mice, a Mouse-Model of Schizophrenia, Show Decreased Levels of Htr2a mRNA in the Anterior Frontal Cortex after Sleep Deprivation Compared to WT Mice

      Elizalde-Rodriguez, Diana; The University of Arizona College of Medicine – Phoenix; Gallitano-Medel, Amelia (The University of Arizona., 2019)
      In the U.S., 1 in 25 adults experience serious mental illness each year. Despite ongoing research efforts, the pathogenesis of schizophrenia remains unknown. The aim of this study is to answer the question “Do Egr3-­/-­ mice, a mouse-­model of schizophrenia, show decreased levels of Htr2a mRNA in the prefrontal cortex (PFC) region of the brain after sleep deprivation (SD) compared to wild type (WT) mice?” Data resulting from the study will shed light on the pathogenesis of such a disabling mental disorder. Our study investigates the interaction between two of the genes linked to increased risk of schizophrenia, the early growth response (Egr) 3 gene and Htr2a, which encodes the serotonin 2a receptor (5HT2AR) in response to SD, a form of stress. We used a cohort of age-­matched pairs of C57BL/6 Egr3-­/-­ and WT male mice. Half of these underwent a SD protocol, while the other half served as a control group. Htr2a mRNA was quantified in four different brain regions via densitometry after it was visualized using in-­situ hybridization. Our findings that Egr3-­/-­ mice show statistically significant decreased expression levels of Htr2a mRNA in the PFC support our proposed biological pathway for schizophrenia risk.
    • What are the physical characteristics of the distal tibiofibular syndesmotic joint in uninjured patients?

      Rahman, Qasim; The University of Arizona College of Medicine – Phoenix; Gridley, Daniel G. (The University of Arizona., 2019)
      The syndesmosis is a crucial component for the ankle joint as any injury to it can immobilize a person. The ultimate goal of treatment is to restore the syndesmosis and ankle joint to their respective pre-injury, anatomic alignments. Few studies have attempted to characterize normal syndesmotic joints. Many of these studies have had certain limitations: small population size, minimal diversity in subject demographics, and very few raters taking part in data collection. The purpose of this study is to review a normal distal tibiofibular syndesmosis and characterize the parameters of an uninjured joint using both computed tomography (CT) and magnetic resonance imaging (MRI).
    • Comparing the Effects of Narrative Nonfiction and Literary Fiction on Empathy Retention in Medical Students

      Shi, Aishan; The University of Arizona College of Medicine – Phoenix; Hartmark-Hill, Jennifer (The University of Arizona., 2019)
      Integration of medical humanities into medical student curricula has been shown to improve medical student empathy and resilience. The purpose of this study is to determine if narrative nonfiction pieces help students retain equal or more empathy skills compared to reading literary fiction. Previous studies show that interventions that utilize medical humanities can vary in medium and genre, and face the challenge of small sample size and confirmation bias due to a lack of randomized trials. In contrast, this study compares the reading of Narrative Nonfiction and Literary Fiction in building empathy in second year medical students randomized to each genre. Participants were asked to read selections from their assigned genre during the intervention period. Baseline, pre-intervention, and post-intervention assessments were measured by the Reading the Mind in the Eyes –Revised. Results demonstrated a statistically significant decrease in empathy across the overall study period, and there was no empathy retention difference between genres. Additionally, female gender identity and increased engagement in the arts and humanities prior to medical school were correlated with higher empathy scores across time. These findings indicate the need for longitudinal and personalised learning in medical humanities for more thorough studies and maximised benefits on empathy retention.
    • A Randomized Control Trial of Benefits of Intrahopsital Exercise on Post-Transplantation Deconditioning in the Pediatric Hematopoietic Stem Cell Transplant Population

      Smith, Charles; The University of Arizona College of Medicine – Phoenix; Ngwube, Alexander (The University of Arizona., 2019)
      Deconditioning is a common adverse effect of short and long-term immobilization. For months pediatric hematopoietic stem cell transplant patients can be quarantined while hospitalized, much of which time is spent immobilized putting these patients at a higher risk for loss of muscle strength, functionality, endurance, and quality of life. Studies have shown that exercise as an effective countermeasure to deconditioning in stem cell transplant patients. However, research is lacking in pediatric HSCT due to the complications associated with treatment. This study was conducted to determine if there is a correlation between intrahopsital exercise and improved functionality, endurance, strength, and quality of life. In addition, this randomized control study looked at the merit and feasibility of adding an exercise routine into treatment plans. We have currently recruited 23 of our target 40 patients, 12 in the control arm and 11 in the intervention arm, ages 8-17 at Phoenix Children’s Hospital. Each participant received baseline measured by an OT or a PT for functionality using (WeeFIM), muscle strength using manual muscle testing (MMT), endurance using the 6-minute walk test, and quality of life using the NIH PROMIS measures. Measurements were taken again at discharge and 6-weeks post-discharge. During hospital admittance the intervention group performed exercise routines 3-times weekly while the control group were encouraged to spend time out of bed. Patients recruited were receiving their first HSCT and did not have any post-HSCT complications such as severe infection or GVHD. Data and results are limited due to the timepoint of the study and the limited number of recruited patients affecting the power of the study. No statistically significant difference is noted between the two arms in functional status, muscle strength, or endurance. There appears to be an increase in quality of life patients in the interventional arm compared to the control arm. Simple analysis has shown that compliance with time out of bed decreases across both groups the further away from transplant. Currently the study is midway, and data is limited to make any conclusions but shows promise.