Sexual and gender-based violence (SGBV) remains a pervasive yet under-addressed issue in humanitarian settings. Refugee and internally displaced person (IDP) camps along the Thai– Myanmar border represent a complex nexus of protracted displacement, ethnic conflict, and limited access to medical and psychosocial care. Although the prevalence of sexual assault in these contexts is well-documented, there is a critical gap in the literature regarding effective, context-specific treatment and intervention strategies. This capstone project conducts a comprehensive review of existing research on sexual assault care in humanitarian crises worldwide and assesses its applicability to displaced ethnic minorities from Myanmar. The analysis considers peer-reviewed studies and applies an equity-focused, trauma-informed lens to assess gaps in current practices. Particular attention is paid to culturally specific barriers to care, the role of gender norms and stigma, and the limitations faced by international aid organizations operating in politically sensitive environments. By identifying key limitations in existing models of care worldwide and highlighting promising community-based approaches, this project seeks to inform the development of more effective and culturally appropriate responses to SGBV in protracted crisis settings.
Mentor: Dinesh Pradhan Program: Pathology Type: Original Research Background: Rosai-Dorfman disease (RDD) is a rare histiocytic disorder with an excellent prognosis involving nodal and extra-nodal tissues. Although skin and soft tissue is the most common extra-nodal site, cutaneous RDD (CRDD) is extremely rare and shows subtle differences in histological findings from extra-cutaneous RDD. Possible association with IgG4-related sclerosing disease has been reported with many cases showing increased IgG4(+) plasma cells. However, there is little data regarding the number and proportion of IgG4(+) plasma cells in CRDD. Methods: Following IRB approval, a total of 68 patients of RDD were retrieved over a period of 34 years and their clinicopathologic, immunohistochemical, and survival information were evaluated. Immunohistochemistry (IHC) for IgG4, IgG, and BRAF V600E was performed in 53 cases in which tissue was available for study. Results: Immunohistochemistry for BRAF V600E was negative (53/53). Cyclin D1 was positive (41/41), and ALK was negative (41/41). CRDD demonstrated no increase in IgG4 (5/5) (0/HPF) or IgG (5/5) in our study. In contrast, extra-CRDD demonstrated a significant increase in IgG4/IgG (10–60%), and IgG4 ranged from 7–35/HPF (30/41). Of 49 patients with known follow-up, only 5 patients (10%) with soft tissue involvement (extra-CRDD) had residual disease or suspected residual disease. No patients died or developed any widespread dissemination. Conclusion: This study further highlights the heterogeneous nature of RDD, with divergence of expression of IgG4(+) plasma cells in CRDD versus extra-CRDD. Interestingly, all patients in this study with residual disease had extra-CRDD. Thus, there continues to be a need for understanding the pathogenesis of RDD for guiding clinical management.
Mentor: Kathryn Hutchins Program: Internal Medicine – Gastroenterology & Hepatology Type: Review Background: Epithelial dysplasia is a risk for colon cancer in patients with long-standing inflammatory bowel disease. The rates of dysplasia detection using virtual-based versus dye-based chromoendoscopy remain controversial. Therefore, we conducted a systematic review and meta-analysis to analyze the available data on this topic. Methods: We identified potentially eligible studies from the MEDLINE and EMBASE databases, searching from inception to September 2024, to compare the differences in virtual-based (VCE) and dye-based chromoendoscopy (DCE) in detecting dysplasia. To be included, studies needed to compare dysplasia detection rates between both DCE and VCE. Effect size and 95% confidence intervals (CIs) were combined using the generic inverse variance method. All statistical analyses were performed by Review Manager 5.4. Results: Our meta-analysis included ten studies that met the eligibility criteria. There were 1,332 participants, with a mean age of 50.7 years, and 52% were males. We found that patients undergoing DCE have a higher rate of detecting dysplasia when compared to VCE with a pooled odds ratio (OR) of 1.56 (95% CI: 1.08 – 2.26; I 2 = 36%; P = 0.02) ( Figure 1). Figure 1 The forest plot demonstrated a pooled odds ratio of dysplasia detection rates for VCE compared to DCE. Conclusion: Our study revealed that DCE is superior in detecting dysplasia lesions. Large scale cohort studies may be required to reinforce this relationship.
Mentor: T. Jason Meredith Program: Family Medicine Type: Case Report Background: Infectious mononucleosis (IM) is contagious and spread via bodily fluids. Symptoms are indolent; may take 4–6 weeks. Periorbital edema (Hoagland sign), a possible early symptom, may occur after fever onset, before exudative pharyngitis, cervical lymphadenopathy; may not be initially present. Team physicians need high suspicion for IM if an athlete presents with periorbital edema without cause. Case: National Collegiate Athletic Association female rower presented for concussion evaluation. Concussion suffered 1 day prior, struck by an oar to the back of the head. Immediate headache and blurry vision; headaches improved but now with difficulty focusing on objects. Friends noticed bilateral upper eyelid swelling. Denied swelling in her extremities. Took NSAIDs for headaches but no longer. The patient was advised to continue University’s Concussion Protocol and follow up in 48 hours; now with worsening fatigue and a desire to sleep all day. Eyelid swelling also worsened. Reported URI symptoms 1 week before the concussion. Conclusion: IM diagnosis was reviewed, and it was discussed that IM may explain the remaining symptoms. Updated American Medical Society of Sport Medicine guidelines on return to play after diagnosis were reviewed with the athlete, coaching staff. The patient was held from normal concussion RTP exercise protocol. Supportive cares for conservative management recommended for remaining symptoms. Symptoms resolved at 2 week follow up. The patient was started on supervised low-intensity cardio training with gradual increase over 1 week. No splenic imaging was completed. The patient returned to full activity 4 weeks after the initial presentation and completed her collegiate season.
Mentor: Kai Yang Program: General Surgery Type: Review Background: First carpometacarpal joint osteoarthritis (CMCJ-OA) is a progressive condition that impacts quality of life. Treatments focus on pain relief and improved function. When non-operative measures fail, surgery with trapeziectomy with/without ligament reconstruction offers durable results. Recent literature describes joint denervation as a minimally-invasive alternative that decreases pain and expedites recovery in first CMCJ-OA. We provide a comprehensive review of the current literature to assess the long-term efficacy and role of denervation first CMCJ-OA treatment. Methods: A literature review identified studies with adults undergoing first CMCJ denervation for osteoarthritis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Reviewers performed screening, data collection/analysis (demographics, technique, and post-operative outcomes/complications), and quality assessment with the Newcastle-Ottawa Scale and National Institutes of Health Quality Assessment Tools. Results: Fifteen studies met inclusion criteria for a total of 360 patients/372 hands. The mean follow-up was 35.5 months (range 6–125.6 months). First CMCJ denervation demonstrated reduced pain and improved hand function. Overall pain score reduction was 75.3% (PRE: 7.13; POST: 1.77, p<0.001). Complications across studies were 18.5% with post-operative paresthesia as the most common (12.8%). Wound-related complications/infections were 3%. The conversion rate of 16.3% to trapeziectomy with ligament reconstruction was reported in seven studies with 36.9 month follow-up (range 12–63.5 months). Conclusion: Surgical denervation is a promising, alternative treatment for patients with first CMCJ-OA. Long-term studies demonstrate success in decreasing overall pain, post-operative complications, and conversion arthroplasty rates. In this study, denervation proves to be an effective, lasting treatment for first CMCJ-OA.
Mentor: Jairam Krishnamurthy Program: Clarkson Family Medicine Type: Original Research Background: The evolution of systemic therapies has improved outcomes for patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Nonetheless, the tolerability and safety profile of systemic therapies represent an area for further improvement. Here, we report the results of a phase II trial evaluating a non-anthracycline, non-platinum adjuvant treatment regimen for patients following initial surgical resection. Method: The study was approved by the Institutional Review Board (IRB) (IRB#318-15). We enrolled patients with stage I or II HER2+ breast cancer who underwent upfront surgery to receive adjuvant treatment with 6 cycles of dose-dense Paclitaxel, cyclophosphamide and Trastuzumab (PC-H) every 2 weeks, followed by 13 cycles of maintenance trastuzumab every 3 weeks to complete 52 weeks of treatment (comprising 19 cycles). The primary objective was to determine the safety and feasibility of adjuvant PC-H measured by the completion rate and the frequency and the grade of adverse events, using National Cancer Institute Common Terminology Criteria. The secondary objective was to estimate relapse-free survival and overall survival. Results: Between 2010 and 2019, a total of thirty-nine patients were enrolled. Of those, 34 patients (87.18%) completed the planned treatment. Severe adverse events of grade 3 or 4 occurred in 27 patients (69.23%), including 3 patients (7.69%) with grade 3–4 decrease in ejection fraction. At median follow up of 5.6 years, all 39 patients were alive. The 5-year relapse-free survival was 94.30% (95% CI: 75.3–100). Conclusions: PC-H regimen demonstrated overall safety and efficacy, yielding high rates of relapse-free survival among patients with early stage (HER2+) breast cancer.
Mentor: Joseph Morgan Program: Orthopaedic Surgery Type: Original Research Background: Blast-related upper extremity injuries sustained during the Independence Day holiday are time- and resource- intensive. The objective of this study was to evaluate incidence of blast-related injuries and system burden against weather and holiday timing. Methods: Available records from 2017–2023 for patients treated by fellowship-trained hand surgeons at a single tertiary institution for blast injuries sustained during the Independence Day holiday period (7 days preceding and following the holiday) were reviewed. This study is IRB exempt. Tourniquet time and return to operating room within holiday period were collected as proxies for system burden. The weather as documented by National Oceanic and Atmospheric Administration data and the day of the week on which Independence Day fell were recorded. Results: Twenty-three blast-related injuries occurred during the defined period. Mean tourniquet time was 70.5 minutes and 10 of the injuries (43.5%) required 13 returns to the operating room within the period. Six of the injuries (26%) occurred each on Tuesday and Sunday while 10 (43.5%) total occurred Friday-Sunday. Fifteen (65.2%) injuries occurred on days with zero or trace precipitation; the maximum amount of precipitation on any day of injury was 0.86 inches. High temperatures ranged from 78–92 degrees Fahrenheit on day of injury. Conclusion: The systematic burden of blast-related upper extremity injuries each year is likely influenced by multiple factors. Injuries in this study were almost evenly split between mid-week and weekend days; most injuries occurred on days without precipitation. Hand surgeons and hospital systems may be best served by optimizing resource flexibility.
Mentor: Ahmad Miri Program: Pediatrics – Gastroenterology Type: Case Report Background: Senna, a natural laxative containing anthraquinone glycosides, stimulates bowel movements. While gastrointestinal symptoms following senna ingestion are well-documented, contact burns secondary to its ingestion are a rare phenomenon, particularly in pediatric patients. Case: We present a previously healthy 2-year-old female, non-toilet trained, who developed loose stools, erythema, and blisters on her buttocks ( Figure 1) after inadvertently ingesting one square of chocolate-flavored senna chew containing 15 mg of Senna. Following clinical evaluation, accidental ingestion of senna was noted as the cause of the burn injury; blisters were ruptured in the emergency room and treated with Bactroban, and oral cephalexin for five days. The pattern of injury raised concerns for physical abuse; a Child Protective Services report was filed, which found no probable cause for abuse. The blisters resolved and healed completely at a follow-up visit. Figure 1 Erythema, 4–5 cm (about 1.97 in) blisters extending from the medial side of the left buttock, and erythema in the diaper area with swelling and skin sloughing on the buttocks. Conclusion: Senna-induced contact burns is a rare but important clinical entity. Though unclear, the mechanism of action is thought to be due to a reaction to fecal matter and prolonged skin exposure. Literature suggests daytime dosages in children requiring senna for constipation to prevent prolonged overnight contact with diaper stool. These burns typically occur following high doses, prolonged exposure, or overnight contact with a diarrheal diaper. Our case underscores the crucial role of healthcare providers in considering dermatological complications associated with senna ingestion in pediatric patients. It stresses detailed examination and history-taking; crucial to differentiate senna-induced contact burns from physical abuse, which can be incorrectly diagnosed, and emphasizes preventive strategies and healthcare provider awareness.
Mentor: T. Jason Meredith Program: Family Medicine – Primary Care Sports Medicine Type: Case Report Background: Hook of the hamate fractures are often seen in sports, presenting with ulnar-sided palmar hand/wrist pain. Definitive diagnosis typically requires advanced imaging. Case: A 20-year-old male baseball player presented for evaluation of left dorso-ulnar wrist pain. The pain started after a round of golf one month prior. No inciting trauma. He initially ignored the pain and continued to practice on it; however, worsening of pain led to an evaluation. The pain worsened with catching pitches and completing batting practice. Mild improvement with rest and anti-inflammatories. No improvement with soft tissue modalities. No prior injuries to that hand/wrist. On examination, vitals were normal. The patient appeared comfortable and was in no acute distress. Left hand/wrist demonstrated no erythema, warmth, atrophy, ecchymosis, or obvious deformity. Tender over the dorsal surface of the hand/wrist at the base of the 5th metacarpal and hamate bone. Non-tender over the palmar aspect of the hamate. Hand and wrist demonstrated full active and passive range of motion (ROM). Pain at end ranges of wrist extension and ulnar deviation. Sensation was intact. Xray of the wrist and hand was unremarkable. Diagnostic injection at the carpometacarpal and hamate joints provided no relief. MRI showed non-displaced fracture of the hook of the hamate. Conclusion: The final diagnosis was fracture of the hook of the hamate. Surgery was performed to remove the fractured hook. Therapy started immediately postoperatively, focusing on swelling reduction and ROM. Six weeks post-op, the player was allowed to return to baseball related activities. He had no further pain and played out the season without limitations.
Mentor: Sara McCall Program: Family Medicine Type: Case Report Background: Chondromalacia patella can be a common cause of patellofemoral pain, which is a frequent complaint seen by clinicians. Physical therapy and oral anti-inflammatory medications continue to be first line treatment. Intra-articular injection therapy may be helpful but has shown inconsistent results. Currently, there are no reported studies involving injections to the patellar facets. Dextrose prolotherapy (DPT) may be effective in providing sustained relief in patients who do not respond to the above measures. Case: A 36-year-old female presents with chronic bilateral knee pain with associated feelings of instability. She has been experiencing symptoms in her left knee for many years. She started to develop the same symptoms in her right knee but worse. She has no known history of knee injury. Her symptoms are worse with bending, squatting, and going up or down stairs. She completed multiple sessions of physical therapy but reports it has not provided any relief. She had 2 bilateral dextrose prolotherapy (DPT) intra-articular injections, which did not provide relief. In this case, a new approach was attempted where the patient underwent 2 palpation-guided DPT injections consisting of 0.5mL 1% Lidocaine and 0.5mL 50% dextrose at the bilateral medial and lateral patellar facets at a 1-month interval. Conclusion: After a series of 2 DPT injections to the bilateral medial and lateral patellar facets, the patient was able to increase her activity and return to running, as well as stairs and squatting. She experienced significant sustained relief, reporting 75% improvement in her symptoms for approximately 10 months.
Mentor: Jennifer M. Davis Program: Internal Medicine – Infectious Diseases Type: Case Report Background: Histoplasmosis is a dimorphic fungus that often presents with symptoms of community-acquired pneumonia. Immunocompromised patients can also present with disseminated disease involving other organ systems. Case: A 25-year-old female with a past medical history of papillary thyroid carcinoma status post-surgical resection, dermatomyositis (managed with mycophenolate and monthly IVIG) presented to the emergency department with progressive shortness of breath associated with fevers, night sweats, and malaise. She had a new 2L oxygen requirement. Laboratory evaluation demonstrated pancytopenia (WBC 3,500, hemoglobin 9.7, platelets 129,000) and elevated liver function tests (AST 106 U/L, ALT 199 U/L, alkaline phosphatase 107 U/L). Chest CT chest and abdomen demonstrated diffuse submillimeter pulmonary nodules, a 1.6 cm pulmonary nodule, and splenomegaly. Serum 1,3 Beta D glucan returned elevated >500 pg/mL. The bronchoalveolar lavage (BAL) specimen showed fungal elements ( Figure 1). Aspergillus galactomannan was elevated at 7.91. Histoplasma antigen returned positive from BAL ( >25 ng/mL), serum ( >25.0 ng/mL), and urine ( >25 ng/mL). The patient received 6 days of intravenous liposomal amphotericin and was transitioned to oral itraconazole to complete 12 months of therapy for disseminated histoplasmosis. Figure 1 Bronchoalveolar lavage cytology with fungal yeast forms identified, consistent with Histoplasma. Conclusion: Patients with immunocompromising conditions are at increased risk for the development of disseminated histoplasmosis, and it is often difficult to assess the degree of a patient’s immunocompromise. The adrenal glands, liver, spleen, and bone marrow are often affected by disseminated disease. Diagnosis of Histoplasma capsulatum is often made by glycoprotein antigen testing, which has better sensitivity and specificity compared to culture. Providers should be aware of cross reactivity between aspergillus galactomannan, histoplasmosis antigens, and blastomycosis antigens.
Mentor: Safina Hafeez Program: Pathology – Hematopathology Type: Original Research Background: The feline McDonough sarcoma (FMS)-like tyrosinase kinase 3 (FLT3) gene is the most frequently somatically mutated gene in acute myeloid leukemia (AML), with internal tandem duplication (FLT3-ITD) mutations being the most common. FLT3 testing is recommended in all AML diagnoses, given they portend a worse prognosis. The goal of our study was to find the frequency of FLT3-ITD in genetically rearranged AMLs and to compare the overall survival among FLT3-ITD mutated and unmutated patients. Methods: The Institutional Review Board approved this study. A search for new acute myeloid leukemias in our database from 2020–2024 yielded 267 cases. Data was obtained for genetic abnormalities, FLT3-ITD, and time interval between the diagnosis and last follow-up or death. The cases were classified as AML with defining genetic abnormalities based on the WHO 5th edition of hematolymphoid tumors. Results: We found 100 cases of AML with defining genetic abnormalities. Of the 100, 66 were FLT3-ITD negative and 34 were positive. Of these, 47 cases (47%) had defined rearrangements, with 41 cases FLT3-ITD negative and six cases positive (12.8%). Of the six positive cases, five patients were alive until the last day of follow-up (2.2–44.5 months). Of the negative cases, 10 patients died of the disease (range of survival, 0.3–12.4 months). No follow-up data available for three patients. There was no significant difference in survival between the two groups (p = 0.67) ( Figure 1). AML with nucleophosmin-1 (NPM1) mutation was the most common AML enriched in FLT3-ITD (82%, 28/34). Figure 1 Survival curves comparing FLT3 positive patients to FLT3 negative patients. Conclusion: FLT3-ITD is uncommon in AMLs with defining genetic rearrangements and there is no significant difference in survival between FLT3-ITD negative and positive cases.
Mentor: Jason Meredith Program: Family Medicine Type: Original Research Background: Travel fatigue is an accumulative disorder due to repetitive travel over a season that results in a buildup of injuries in athletes. A major change in the Minor League Baseball (MiLB) schedule occurred for the 2021 season that reduced cumulative travel load. The purpose of this study was to observe the effect of travel load on position specific injury frequency. Methods: A retrospective cohort study analyzed data from MiLB players using a public database from four seasons pre-schedule change (2016–2019) and four seasons post-schedule change (2021–2024) at each level of baseball (AAA, AA, A+, A). Data was further separated by position: pitchers, catchers, infielders, and outfielders. An ANOVA analysis was used for comparison between positions. Results: Exposures were calculated by primary position played. Pre-schedule change, 7733 injuries occurred across 858,829 exposures; post-schedule change, 6430 injuries occurred across 844,172 exposures. According to the ANOVA analysis, there was a significant position by schedule change interaction effect across all variables (p < 0.05). In the post-schedule change period, pitchers saw a statistically significant increase in the ratio of injuries, whereas position players saw a significant decrease in the ratio of injuries. Conclusion: The schedule modification implemented in minor league baseball appears to have led to a statistically significant reduction in the overall number of injuries. The findings indicate that while the schedule change alleviates injury frequency among MiLB players, there is a need for further strategies to address injury severity and duration, particularly for pitchers.
Mentor: Subin Mathew Program: Neurological Sciences Type: Review Background: Accurate prognosis of neurologic outcome after cardiac arrest is currently hampered by the lack of robust prognostic predictors. Ideal biomarkers promise an immediate relationship with the prognosis-determining injury, as well as objective and reliable measurements by means of standardized assay procedures. Unfortunately, no such ideal biomarker of neurologic damage after cardiac arrest has been clearly established. MicroRNAs are attractive novel biomarker candidates due to their immediate relationship with cell metabolism, high stability, and presence in multiple body fluids. Methods: We performed a literature search of multiple databases using keywords pertaining to microRNA, cardiac arrest, and prognostication, using two independent reviewers. Results were screened and selected based on predefined inclusion criteria and compiled in a data sheet. Results: We identified 12 studies at the time of our search with detailed reporting on 28 different microRNAs. miR-124 and miR-122 were studied most often, while miR-21, miR-9, miR-574, and miR-483 were studied more than once. Not all studies were methodically similar. In addition, results were not always reported in a uniform way between studies. The prognostic potential of specific miRs was reported in odds ratio, AUC, and mean differences between groups. Conclusion: Although evidence for the use of specific miR biomarkers in cardiac arrest is growing, the evidence is, at this point, mostly restricted to a few candidates and weakened by the heterogenous reporting of results. MiR-124 is currently the best studied candidate, however, it has not consistently been proven the best available marker. Multiple other candidates are potentially understudied, and more work is needed to allow better comparison between candidates.
Mentor: Lois J Starr Program: Pediatrics - Medical Genetics Type: Original Research Background: Clinical genetics has been revolutionized by rapid improvements in testing. The Medical Genetics consult team serves five hospitals. Prior to 2019, prior authorizations limited genetic testing. In 2019, these restrictions were lifted for microarray and cytogenetic testing. By the end of 2022, most institutions approved our ordering of rapid exome sequencing for patients with insurance without a formal prior authorization. These changes and advancements improved the quality and timeliness of care for patients and reduced the burden of additional cost considerations for families. Methods: Every inpatient consult performed since January 2021 was recorded with patient demographics, location, indication, recommendations, and results. Preliminary analysis assessed consult patterns, testing recommendations, and results. No IRB was utilized for this project. Results: Preliminary review identified 1,177 genetic consults with 1,039 tests initiated. Neonatal intensive care units consistently accounted for 60–70% of consults each year. Only 1% involved adult patients. Diagnostic yield improved annually, with pathogenic results identified in 34%. Non-diagnostic results accounted for 43%, while variants of uncertain significance rates decreased from 37% in 2021 to 15% in 2024. The proportion of pathogenic diagnoses increased from 27% in 2021 to 38% in 2024. Conclusion: Our findings underscore the critical role of inpatient genetic consultations in patient care. An increased diagnostic rate and reduction of uncertain results occurred since 2021, likely due to improved testing processes, availability of exome testing, and variant curation. Additional analyses will explore correlations between consult characteristics, test methodologies, and clinical outcomes. Our experience highlights the transformative potential of integrating advanced genetic diagnostics into inpatient care models and reinforces the importance of equitable access.
Mentor: Jason Meredith Program: Family Medicine Type: Original Research Background: Travel fatigue is an accumulative disorder due to repetitive travel over a season that results in a buildup of injuries in athletes. A major change in the Minor League Baseball (MiLB) schedule occurred for the 2021 season that reduced cumulative travel load; we hypothesized that it also reduced the number of injuries. Methods: A retrospective cohort study analyzed data from MiLB players using a public database from four seasons pre-schedule change (2016–2019) and four seasons post-schedule change (2021–2024) at each level of baseball (AAA, AA, A+, A). A paired t-test was used for analysis with an alpha level of 0.05. Results: Exposures were calculated by primary position played. Pre-schedule change, 7733 injuries occurred across 858,829 exposures; post-schedule change, 6430 injuries occurred across 844,172 exposures. There was a statistically significant reduction in the total injuries on the injured list (IL) post-schedule modification (p = 0.008), with a moderate effect size (Cohen’s d = 0.76). Total days on the IL decreased from 291,544 pre-schedule change to 269,760 post-change, though not significantly (p = 0.103). Average days per injury increased slightly but not significantly (p = 0.088). Conclusion: The schedule modification implemented in minor league baseball appears to have led to a statistically significant reduction in the overall number of injuries. The findings also indicate that there is a need for further strategies to address injury severity and duration. This is the first study to link scheduling associated travel load to injury frequency. Our data may be extrapolated to other leagues to assist medical staff in advocating for their athletes’ health and wellbeing.
Mentor: Vijaya R. Bhatt Program: Internal Medicine – Oncology & Hematology Type: Review Background: Cancer survivors often experience physical and psychological challenges, such as pain, fatigue, sleep disturbances, and depression, which impair their quality of life. While exercise interventions have proven beneficial for survivors of solid tumors, research on their impact on blood cancer survivors remains limited. This review examines the current evidence of the impact of exercise interventions in patients with hematologic malignancies, with a focus on interventions used, study participants characteristics, reported outcomes, and limitations. Methods: The literature search included research articles that met the following criteria: included adults aged 18 years or older, who currently have or previously had a hematologic malignancy, where an exercise intervention was being implemented and were published in English from data inception until March 15th,2024. Results: Eighteen studies were found, feasibility studies (n=10), randomized controlled trials (n = 7), and a randomized parallel trial (n = 1). Participants were predominantly younger adults and mostly white. The most common intervention was combined aerobic and resistance exercises (n = 10), typically delivered three times per week over 8–12 weeks. Intensity was mainly monitored through heart rate devices. Feasibility studies demonstrated adherence rates of 66–87% and retention rates of 70–95%, with improvements reported in fatigue, quality of life, physical function, and cardiorespiratory fitness. Randomized trials reported similar benefits but showed mixed results regarding fatigue, quality of life, and physical fitness. Conclusion: This review highlights the potential of exercise interventions to improve outcomes in hematologic malignancy patients. However, larger, diverse studies are needed to address long-term effectiveness, psychological impacts, cost-efficiency, and barriers to implementation.
Mentor: T. Jason Meredith Program: Family Medicine – Primary Care Sports Medicine Type: Original Research Background: The impact of pitch clock rules in professional baseball on pitcher health and safety remains unclear. This study examines the relationship between pitch clock regulations and the number of days pitchers spent on the injury list (IL) in minor league baseball (MiLB). Methods: Data was obtained from a public database containing all MiLB IL entries for the 2012–2024 seasons. Pitching injuries were separated into three groups: Group 1 (no pitch clock rules), Group 2 (original pitch clock rules), and Group 3 (updated pitch clock rules with disengagement limits). A one-way ANOVA, Tukey’s post hoc tests, Levene’s test, and effect size calculations were completed. Results: In total, 11795 injuries were reported across the 2012–2024 seasons and included in the analysis. Significant differences were observed among the groups in days spent on the IL (p < 0.001). Group 3 exhibited the highest mean injury duration (total n injuries = 3271, days on IL = 53.88 +/− 54.05 days), followed by Group 1 (total n injuries = 5340, days on IL = 44.11 +/− 45.35 days) and Group 2 (total n injuries = 3184, days on IL = 39.54 +/− 45.74 days). Tukey’s post hoc tests revealed that Group 3 had significantly higher injury durations compared to Groups 1 and 2 (p < 0.001 for both comparisons). Conclusion: The updated pitch clock rules were associated with longer appearances on the IL, suggesting potential unintended consequences of increased game pace and limited disengagement opportunities. These findings highlight the need for further investigation into the physical demands and recovery implications of pitch clock regulations.
Mentor: Kelsey Noble Program: Clarkson Family Medicine Type: Case Report Background: This is a case of a patient with type 2 diabetes mellitus (T2DM) presenting with diabetic ketoacidosis (DKA) instead of the typical hyperosmolar hyperglycemic state. Case: A 54-year-old female presented to the emergency department due to 1 week of fatigue, polyuria, and polydipsia. Medical history included type 2 diabetes mellitus, hypertension, hyperlipidemia, obesity, and diffuse idiopathic skeletal hyperostosis (DISH). She had been diagnosed with T2DM six months earlier with an HbA1C of 6.6. She chose lifestyle modifications as treatment. On arrival, her glucose was greater than 800, and she had a high anion gap metabolic acidosis with beta hydroxybutyric acid of 3.6, which met the criteria for DKA. She required an insulin infusion with frequent glucose checks and metabolic panels to correct the abnormalities. A repeat HbA1C was 12.5, and type 1 diabetes labs for autoimmunity were obtained, and all were negative. Endocrinology was consulted and recommended long acting, short acting, and correction insulin. In addition, per their review of the patient’s presentation and lab results, it was speculated that she may have atypical ketosis prone diabetes. She was discharged home and followed up with endocrinology outpatient and has had improvement in her A1c and has been able to reduce her diabetic medication dosages. Conclusion: There is a subtype of type 2 diabetes known as ketosis prone diabetes where an individual may require high doses of insulin for a short period of time but can show rapid improvement in their HbA1C. Furthermore, research has shown that there are more subtypes of type 2 diabetes that predispose patients to more accelerated advancement to CKD, cardiovascular disease, retinopathy, and neuropathy, which makes the screening for diabetic complications important.
Background: We evaluated perioperative intrathecal morphine (ITM) compared with placebo or standard postoperative pain strategies in adults undergoing elective posterior lumbar fusion. Methods: A systematic search of EMBASE, MEDLINE, the Cochrane Library, and Google Scholar (December 12, 2023) identified studies involving ITM in posterior lumbar fusion. Eligible patients were ≥18 years. Two reviewers extracted outcomes and assessed non-randomized studies with the Newcastle-Ottawa scale. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- and random-effects models. Results: Eleven studies met the inclusion criteria. ITM significantly lowered opioid requirements within 24 hours (MD −0.72, 95% CI [−1.30, −0.14], I 2 = 91.08%, p = 0.015) and pain scores at 24 hours (MD −0.57, 95% CI [−1.01, −0.13], I 2 = 73.17%, p = 0.010). Reductions were also seen in pain scores at 48 hours (MD −0.63, 95% CI [−1.55, 0.29], p = 0.178), hospital stay (MD −0.71, 95% CI [−1.77, 0.36], p = 0.191), sedation (OR −0.18, p = 0.594), and respiratory depression (OR −0.08, p = 0.782), though these were not statistically significant. ITM increased the incidence of pruritus (OR 1.04, 95% CI [0.45, 1.64], I 2 = 43.55%, p < 0.001), with non-significant rises in urinary retention (OR 0.45, p = 0.070) and nausea/vomiting (OR 0.03, p = 0.847). Conclusion: Although based on relatively small and methodologically heterogeneous studies, these analyses suggest that perioperative ITM enhances analgesia and maintains an acceptable safety profile following posterior lumbar fusion.
