Medical Scholar Explorers

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

Sujata Dalal is a first-year medical student at Texas A&M College of Medicine conducting burn research under the guidance of Karen Kowalske, M.D., who is in the Department of Physical Medicine and Rehabilitation at UT Southwestern Medical Center. Using the North Texas Burn Rehabilitation Model System, they aim to evaluate trends in demographics of pediatric burn victims, determined as patients aged 17 or younger, admitted for burn injury from 2015 to 2020, and cause of burn. Variables such as age, gender, race, ethnicity, total body surface area (TBSA), and etiology will be compared. Determining and identifying if there is a common etiology of burns to certain groups will facilitate targeted interventions and prevention and educational efforts in these vulnerable populations.

Swati Iyer is a first-year medical student at Texas A&M College of Medicine conducting research under the mentorship of both Dr. Jacob Szeszulski an Assistant Professor and Rebecca Seguin-Fowler, an Associate Professor in Texas A&M AgriLife Research, respectively. Their MSE research project is investigating how school health policy environments can contribute to nutrition, physical activity and positive health outcomes in the youth. Because there is a disproportionately higher rate of obesity for children living in rural communities, compared to children living in urban communities, improving health behaviors may likely help to decrease the amount of rural youth developing chronic diseases as adults. As children spend a large amount of their time at schools, the development of effective Local School Wellness Policies (LWPs) will likely prove beneficial to improving children’s health behaviors and environments. Furthermore, it is important to note that the quality and implementation of such LWPs are related to district-level resources and are linked to social determinants of health (SDOH). Through this research project, our team will analyze if there are differences in rural school health policy environments when compared to urban school health environments, as well as differences in the implementation of these LWPs. Identified differences may be a predictor for the higher obesity rates seen in children living in rural communities.

Otito Ojukwu is an M1 student at Texas A&M College of Medicine and is conducting a Medical Scholar Explorer (MSE) research project in the Department of Medical Physiology, under the mentorship of Mariappan Muthuchamy Ph.D. in collaboration with Xu Peng M.D, Ph.D. His MSE project is investigating the role of Mettll4 in heart function and impending heart failure. The N6-Methyladenine (m6A) modification is the most abundant and reversible modification on mRNA and methyltransferase like 14 (Mettll4) protein plays an essential role on mRNA modification. Our working hypothesis is that knock down expression of Mettl14 downregulates contractile and regulatory proteins in cardiac muscle thereby, decreasing heart function. This could have wide applications for patients with heart failure. Dr. Peng’s lab generated a mouse line (cardiac-Mettl14-/-) in which Mettl14 gene is knocked out specifically in cardiac muscle cells. We will evaluate heart function by comparing echocardiogram measurements in the control and cardiac-Mettl14-/- mice groups. Additionally, we will examine the changes of transcriptome in Mettl14 knockout hearts by RNA-Seq. We anticipate that Mettl14 would decrease the contractile and regulatory proteins in cardiac muscle. If our working hypothesis is correct, our data would demonstrate that Mett114 protein can potentially be an epigenetic regulator of heart function, which can be a therapeutic target for treatment options for patients suffering from heart failure.

Shyam Ramachandran is a first-year medical student at Texas A&M College of Medicine conducting clinical research in orthopaedic surgery at the Department of Surgery and Perioperative Care at Dell Medical School under the guidance of Dr. David Ring, M.D., PhD. Their research project aims to understand treatment options for femoral neck fractures from the surgeon and patient points of view. Previous studies suggest advantages for total hip arthroplasty compared to hemi-arthroplasty and vice versa. For example, a retrospective study out of Canada that reported a reduced risk for revision as well as decreased health-care costs within the first year after surgery for the THA group compared to hemi-arthroplasty (Ravi et al, J. Bone Joint Surg Am, 2019). In contrast, a large retrospective cohort of over 70,000 patients, reported lower complication and dislocation rate for patients receiving a hemi-arthroplasty compared to THA, in patients with 2 year follow-up (Wang et al, J. Orthop Trauma, 2017. This MSE study aims to understand which patient characteristics surgeons consider when deciding for a total hip arthroplasty or a hemi-arthroplasty, and which surgeon factors are associated with that decision. The outcomes of this study will help orthopaedic surgeons provide optimal care for patients presenting with a femoral neck fracture.

Matt Thompson, an M1 student at Texas A&M College of Medicine, is investigating the role of the tryptophan metabolite indole in inflammation of the gut after spinal cord injury (SCI) under the guidance of Cédric Geoffroy, Ph.D. Up to 60% of SCI patients are known to suffer from neurogenic bowel dysfunction (NBD). The mechanism of the induction of NBD following SCI is largely unknown.

The purpose of this MSE project is to understand the relationship between the cytokine IL-17A, which induces neuroinflammation and impedes recovery of function after SCI, and indole, which has been shown to be reduced in the colon after SCI, and to prevent gut dysbiosis in mouse models of colitis via the reduction of inflammation and IL-17A in particular.

Using both genetic (IL-17 Receptor-A KO mice) and pharmacological (indole injections) approaches, this project aims to determine the therapeutic potential of administering indole after SCI in reducing colonic and systemic inflammation, and inducing functional recovery after SCI.

Kayla Callaway is an M1 student at Texas A&M College of Medicine who is conducting research in the topic of how aging affects bone loss following spinal cord injuries (SCI) under Cédric Geoffroy, PhD and Michelle Hook, PhD, both in the Department of Neuroscience and Experimental Therapeutics. There are currently no studies on the effect of aging on bone loss following a SCI yet the age of those who obtain SCI is increasing. As a result, these individuals are likely to be diagnosed with osteoporosis or osteopenia and are much more likely to have a bone fracture. In addition, over half of such cases result in complications, such as respiratory and urinary tract infections, venous thromboembolic events, fracture non-unions and depression. As stated, there are a multitude of unmet health needs for this specific population of patients and research has the potential to provide treatment options, such as load and maintenance incorporated into physical therapy to maintain bone mass. We hypothesize that an SCI-induced reduction in weight bearing regarding the hind limbs will further worsen age-induced bone degeneration. This may be able to provide a preventative measure for many of the added complications prevalent post-SCI.

Sabik Chowdhury, an M2 student at Texas A&M College of Medicine, is conducting a clinical research project under the guidance of Maheswari Ekambaram, MD, a pediatric hospitalist at Baylor Scott & White Medical Center - Round Rock. Community-Acquired Pneumonia (CAP) is one of the most common severe bacterial infections in the pediatric population, with more than 3 million cases per year in the United States. In 2011, the Pediatric Infectious Disease Society (PIDS) and the Infectious Disease Society of America (IDSA) published the first set of evidence-based guidelines for the diagnosis and treatment of CAP. Unfortunately, guideline discordant practices continue to persist nationwide. We will assess the variability in antibiotic prescribing for CAP across several Baylor Scott & White emergency departments in Central Texas and attempt to understand the factors that contribute to this. Our study hypothesis is that there will be a significant degree of variability in guideline adherence and that there are non-clinical patient and physician characteristics that are associated with this. The information collected in our MSE project is anticipated to provide recommendations for best practices to improve pediatric patients’ long-term CAP outcomes.

Jess Hatfield, an M1 student at Texas A&M College of Medicine, is conducting a research project investigating the effect of medical students on physician productivity, under the guidance of Gabriel Neal, MD a Texas A&M COM Clinical Associate Professor and family medicine physician at Texas A&M Health Family Care Clinic. There is currently a lack of published data on the effect of medical students on physician productivity in an outpatient primary care setting; this data is helpful in negotiations between medical schools and affiliated clinical sites. Our study seeks to first analyze data from CHI St. Joseph’s comparing the productivity of 12 primary care physicians with and without medical students, measured in the number of patients seen. Next a qualtrics survey will be sent to the participating physicians to assess how they believe medical students affect their productivity. The conclusions from this study will be important for negotiations on payment for student preceptorships between clinical sites and medical schools.

Marita John is an M1 student at the College of Medicine who is co-writing a review on Super Refractory Status Epilepticus (SRSE) under the guidance of Batool Kirmani, MD, FAAN, FAES, Affiliated Clinical Professor at Texas A&M University College of Medicine and Director of the CHI St. Joseph Health Epilepsy and Functional Neurosurgery Program. Super Refractory Status Epilepticus patients have seizures-like activities that persist after 24 hours of use of anesthetic agents or relapse when trying to withdraw from this treatment. SRSE is a serious condition with a mortality rate between 30 and 50%. Furthermore, these patients are at risk for neuronal injury as a result of failure of medications to terminate seizures. Their review focuses on current therapeutic approaches for SRSE, the outstanding challenges, and the prognosis with a final discussion of future directions of SRSE such as having a comprehensive meta-analysis of prognostic factors and having trials comparing newer therapies to treat this condition.

Jessica Madry is an M1 student at the Texas A&M College of Medicine. She is conducting research, under the guidance of Michelle Hook, PhD Associate Professor in the Department of Neuroscience and Experimental Therapeutics, focusing on depression and cognitive decline after spinal cord injury (SCI) in a transgenic rat model of Alzheimer’s Disease (AD). The diagnosis of depression is three times more prevalent in people with SCI compared with the able-bodied population. Underscoring the impact of this affective disorder, suicide attempts are also three times more prevalent in people with SCI. SCI also impairs quality of life and provides many physical and psychological challenges post injury for both patients and their caretaker(s). Patients with SCI are also two times more likely to develop AD and related dementias. Even mild AD robs them of memory and cognitive abilities, further impacting daily functioning and quality of life, and highlighting the importance of addressing the unmet health needs of this population. Indeed, the risk of cognitive impairment is up to 13 times higher in people with SCI. As a result, up to 60% of people living with SCI develop chronic challenges with learning and memory, executive function, attention, and processing speed. However, relatively little is known about the neurophysiological signaling pathways that may contribute to these specific symptoms. To address this, we will use a transgenic rat model (TgF344-AD rats) of AD to look at how SCI might influence the brain. We hypothesize that the molecular changes inherent to SCI interact with genetic or epigenetic factors to increase susceptibility to depression, cognitive decline, and the development of neuropathological hallmarks of AD. Initial studies will determine whether SCI does, in fact, accelerate the expression of AD symptoms. If so, we will use this powerful model system to interrogate molecular changes induced by SCI and identify the causal factor(s). In doing so we hope to contribute to the understanding of depression, cognitive dysfunction, and neuropathology after SCI and to improve quality of life for people living with this injury.

Lynnsey McLain, an M2 student at Texas A&M College of Medicine, is writing a review article focusing on the epigenetic mechanism underlying plasma cell myeloma under the guidance of Carlos Tirado, M.D., Section chief, cytogenetics at Baylor Scott and White in Temple, Texas. The pathogenesis of plasma cell myeloma (formerly called multiple myeloma) can be attributed to chromosomal abnormalities, disruptions in the bone marrow microenvironment and numerous epigenetic mechanisms. Specifically, the epigenetic events behind this malignancy drive disease progression, from an asymptomatic, precancerous state (MGUS) to plasma cell myeloma and eventually plasma cell leukemia, a particularly aggressive disease. Beyond the tumorigenesis, epigenetic events also facilitate drug resistance of plasma cell myeloma as well as mechanisms of immune evasion. These epigenetic events can be sorted into three classes of mechanisms, including DNA methylation events, histone modifications and noncoding RNA activity (particularly miRNAs and lncRNAs.) This project aims to analyze these specific epigenetic mechanisms and their potential to be targeted with new therapeutics to improve understanding and future management of plasma cell myeloma.

Kacie Mitchell, an M2 student at Texas A&M College of Medicine, is conducting a research project investigating local anesthetic toxicity under the mentorship of Michael Hofkamp, M.D., Director of Obstetric Anesthesia at Baylor Scott and White Medical Center in Temple. This retrospective study seeks to determine the incidence of toxicity in patients who receive peri-articular injections during hip or knee arthroplasty procedures. It is common for patients to receive high-dose injections of local anesthetics such as ropivacaine to decrease the amount of post-operative pain. Although the primary symptoms of local anesthetic toxicity are quite apparent (cardiac arrest or seizures), subclinical symptoms may present as altered mental status, rigidity, or cardiac ischemia. Our work and further research will give anesthesiologists and orthopedic surgeons involved in these procedures a better understanding of the efficacy and safety of these injections.

Sarah Momin is an M1 student at Texas A&M College of Medicine who is co-authoring an abstract and case report investigating the neurological seizure complications of Sars-CoV-2 under the mentorship of Batool F. Kirmani, MD, FAAN, FAES Clinical Professor, Affiliate faculty at Texas A&M College of Medicine, and Director Epilepsy and Functional Neurosurgery Program, CHI- St. Joseph Health. As the SARS-CoV-2 pandemic continues to be on the rise globally with new strains emerging, clusters of symptoms across organ systems are still being described. In addition to respiratory symptoms, neurological effects of the virus contribute significantly to morbidity and mortality. Early landmark studies from Wuhan, China have indicated upwards of 36% of hospitalized patients who tested positive for SARS-CoV-2 also experienced neurological symptoms, including but not limited to, acute cerebrovascular accidents, impaired consciousness, and muscular injury. Further studies have shown that patients may also experience loss of smell and taste, seizures, confusion, enhanced reflexes, and other neurological signs. Our report focuses on a SARS-CoV-2 positive patient who presented with right sided stiffness and encephalopathy. With a full clinically extensive workup coming back negative and with paraneoplastic syndromes and secondary causes being ruled out, our patient’s neurological manifestations were attributed to rare new onset parasagittal seizures in the presence of SARS-CoV-2 based on semiology, EEG findings, and complete symptom resolution with anticonvulsants. Further studies are needed to understand the multifaceted manifestations of COVID-19 and the neurological signs that may present to better diagnose and treat such patients.

Sarah Momin second research project is co-authoring a systematic review article investigating the effects of ethanol on fetal vascular development under the mentorship of Rajesh C. Miranda, Professor, at Texas A&M College of Medicine, Department of Neuroscience and Experimental Therapeutics and Interdisciplinary Program in Neuroscience. Fetal Alcohol Syndrome (FAS) is the most severe disease in the spectrum of conditions related to alcohol teratogenicity with risk factors that include increased alcohol exposure in utero, smoking, genetic factors, and lower socioeconomic status. Children with FAS have unmet nutritional needs and have mothers who abuse alcohol or other teratogens. There are currently no approved drugs for treatment of FAS, which warrants more investigation into the mechanism of FAS to move towards the goal of gene targeted therapies. FAS often presents with three cardinal features of craniofacial dysmorphology including a smooth philtrum, short palpebral fissures, and a thin upper lip vermilion. Other findings include intellectual disability, neurological deficits, and neuropathological anomalies. Diagnosis requires a team of physicians and a geneticist with expertise in malformation syndromes, who look for the cardinal signs, perform neuropsychological and neurodevelopmental assessments, and perform genetic testing. Treatment is currently limited to avoidance of maternal use of alcohol during pregnancy and usage of nutritional supplements such as choline or antioxidants. Stem cell therapy is becoming a more explored method to regenerate damaged neurons, however there is still a need for a drug targeted therapy to alleviate the symptoms and deficits of the children suffering from FAS. Our systematic review focuses on the mechanisms by which alcohol and other teratogens affect fetal blood vessel growth and development, which will contribute to a better understanding of how FAS develops, and which areas drugs may be able to target for treatment.

Chanyanuch Nakapakorn, an M1 student in the College of Medicine, is conducting a translational research project investigating liver tumor metabolism and metastasis under the guidance of Sanjukta Chakraborty, PhD Assistant Professor in the Department of Medical Physiology at the Texas A&M College of Medicine. The aggressivity of cancer metastasis is closely tied to patient’s prognosis. Research shows that alterations in bioenergetics and mitochondrial gene expressions in cancer patients may promote tumor metastasis into lymph nodes. However, molecular mechanism of cancer metastasis remains poorly understood. Our project aims to evaluate clinical case reports and utilize various molecular tools, such as PCR, immunofluorescence and cell culture, to identify genetic alterations present in cancer patients to establish possible links to factors responsible for tumor cells invasion into lymphatic endothelial cells.

Tran Nguyen an M2 student in the College of Medicine, is writing a literature review on pediatric anti-seizure medications under the mentorship of D. Samba Reddy, PhD, RPh, a Professor of Neuroscience and Experimental Therapeutics at the Texas A&M College of Medicine. An estimated 400,000 children are afflicted with epilepsy in the United States. Symptoms during a seizure vary depending on the type and cause temporary abnormalities in behaviors, sensations, muscle tone or movements (twitching, stiffness or limpness), or states of awareness. Febrile seizures and genetic disorders associated seizures are common in children. Status epilepticus, a prolonged seizure or multiple seizures lasting more than 5 minutes, is a common neurological emergency in children. Given the vulnerabilities of physiologic and obvious anatomical differences in children compared to adults, anticonvulsant treatments should be properly tailored for the pediatric population. The main goal is to systematically review current clinical management of epilepsy, acute seizures, and status epilepticus in the pediatric population. It also covers childhood epilepsies, including Dravet Syndrome, Lennox-Gastaut Syndrome, Fragile X-Syndrome, CDKL5 and other neurodevelopmental disorders associated with seizures.

Kaci Orr, an M1 student at Texas A&M College of Medicine, is conducting a clinical research project under the guidance of Maheswari Ekambaram, MD, a pediatric hospitalist at Baylor Scott & White Medical Center – Round Rock. In 2011, the Pediatric Infectious Disease Society (PIDS) and the Infectious Disease Society of America (IDSA) published the first set of evidence-based guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP) in infants and children. Despite this, guideline-discordant prescribing that increases the risk of antibiotic-associated adverse events and antibiotic resistance is still a significant problem nationwide. We will analyze the variability in antibiotic prescribing for the management of CAP in pediatric patients across several Baylor Scott & White Health emergency departments in Central Texas and explore possible factors associated with this variability. Based on similar studies performed in inpatient and outpatient settings, we hypothesize that there will be a significant degree of variability in antibiotic prescribing for this condition and that non-clinical patient and clinician characteristics will be associated with this variability.

Kelbi Padilla, an M1 student in the College of Medicine, is conducting research under the guidance of Kayla Bayless, PhD Associate Professor in the Department of Molecular and Cellular Medicine at Texas A&M College of Medicine. They are investigating the role of miRNA, specifically miR-17, in the development of preeclampsia (PE), a prevalent condition characterized by hypertension and proteinuria during pregnancy. The etiology of PE is related to a loss of placental surface area for maternal-fetal nutrient exchange due to failure of fetal trophoblasts to invade the decidua. Subsequently, vascular growth and development are reduced. An ongoing collaboration between Drs. Choudhury and Bayless discovered microRNA-17a (miR17a) was upregulated in the first trimester of pregnant women that went on to develop preeclampsia. Thus, the aim of this project is to determine if miR-17 alters epigenetic regulation and cytoskeletal destabilization in developing blood vessels to determine if miR-17 is not only responsible for decreased vascularization in PE but might also accurately predict the onset of PE.

Elias Perli, an M1 student in the College of Medicine, is conducting a clinical research project investigating whether sildenafil may improve urinary leakage in patients with spinal cord injuries (SCI) under the guidance of Jonathan A. Friedman, MD, a neurosurgeon at The Texas Brain and Spine Institute (TBSI). Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor that stimulates vasodilation and is thought to function by increasing blood flow throughout the body. In previous studies in women with urinary incontinence, sildenafil decreased the number of urinary leaks they had per week. For this study, SCI patients will be recruited from Texas Brain and Spine Institute and/or CHI St. Joseph’s Rehabilitation Hospital. The study scheme includes first, identifying potential subjects from the TBSI database and then performing a prescreening. Second, a first in-person visit for informed consent, medical screening, randomization, and baseline measures of subjects. Baseline measures include bladder diary, quality of life, and sildenafil drug levels. Once enrolled, patients will be randomly assigned to take either sildenafil (20 mg) or placebo. This study is anticipated to shed light on novel treatments to improve the quality of life of SCI patients suffering from urinary incontinence.

Elias Perli, an M2 student in the College of Medicine, is conducting a literature review research project investigating microglia polarization as a potential therapeutic target for post-traumatic epilepsy (PTE) due to traumatic brain injury (TBI) under the guidance of D. Samba Reddy, PhD, RPh, a Professor of Neuroscience and Experimental Therapeutics at the Texas A&M College of Medicine. Traumatic Brain Injury (TBI) is a change in normal brain function caused by an external insult. More than 3 million people in the United States suffer a TBI annually, accounting for around 300,000 hospitalizations and 50,000 fatalities per year. One notable sequela of TBI is PTE, a neurological disorder where late spontaneous recurrent seizures develop following a TBI. Epileptogenesis may begin after the TBI and become suppressed months/years after the brain insult occurred; potentially delaying diagnosis of PTE after the primary brain trauma. PTEs make up around 20% of symptomatic epilepsies, and 5-6% of all epilepsies in general. Current long-term PTE treatment is limited to the acute use of anti-epileptic drugs (AEDs), prompting the need to investigate non-neuronal targets/mechanisms other than ion channels, such as: microglia, enzymes, oxidative stress molecules, and genetics. This research will investigate the role of microglial polarization into M1 (pro-inflammatory) and M2 (anti-inflammatory) phenotypes in neuroinflammation, as seen in PTE, and its potential as a new therapeutic target on PTE’s chronic inflammation and long-term treatment.

Ambeka Rajvanshi is an M2 student at the College of Medicine who is writing a review on the role of lipid-droplet-accumulating-microglia in aged and neurodegenerative states under the guidance of Ashok Shetty, PhD, Professor in the Department of Molecular and Cellular Medicine, and Associate Director for the Institute for Regenerative Medicine. Alzheimer’s Disease (AD) is the most common cause of dementia and affects roughly 40 million people worldwide. Approximately 90% of AD cases result from mutations in Apolipoprotein (ApoE) E3 and E4, genes associated with proteins involved in lipid transport. Recent models have suggested that an increase in lipid-droplet-accumulating microglia (LDAM) are associated with aged and neuroinflammatory states such as in AD. While current AD therapeutics provide limited relief from clinical symptomology and are not curative, LDAM research has the potential to refine and improve current AD therapies. Their review focuses on current therapeutic strategies for neurodegenerative diseases such as AD, the role that microglia and LDAM play in aging and AD, and future applications and perspectives of this research.

Riddhi Rane, an M1 student at the college of medicine was a co-author in pediatric stroke review article under the guidance of Dr. Batool F. Kirmani in the Endovascular Therapy and Interventional Stroke Program in the Department of Neurology at CHI St Joseph’s Health Regional Hospital in Bryan, TX. Pediatric stroke is a rare occurrence and is often diagnosed with significant delay. This can result in debilitating consequences following the stroke that may remain for the remainder of life. Often, clinical care for pediatric stroke is extrapolated from adult data and experiences. However, the presentation of pediatric stroke may vary widely from that of adults and therefore, may result in treatment ambiguities and inaccuracies. Treatments such as tissue plasminogen activatory (tPA) and mechanical thrombectomies are performed on a case by case basis. Due to the rarity of pediatric stroke, very little randomized control trial data exists to determine the standard of care for children specifically. Where randomized control trial data lacks, there are case studies and retrospective meta-analyses to shed some light. This project aimed to provide a comprehensive understanding on the current limitations in pediatric stroke research thorough literature review on the recent developments and updates in the field. Their work was recently published in Aging and Disease. Link to review paper: http://www.aginganddisease.org/EN/10.14336/AD.2021.0219

Monica Vegiraju, an M1 student in the College of Medicine, is conducting a research project investigating maternal alcohol and nicotine polysubstance use effects on fetal brain development under the guidance of Rajesh Miranda, PhD and professor at the Texas A&M College of Medicine. Prenatal alcohol exposure is the leading cause of preventable birth defects and development disabilities. According to the CDC, 40% of women who used alcohol during pregnancy also reported simultaneous use of at least one other substance, most often tobacco. Research shows that stopping even one of the substances during pregnancy can prevent irreparable damage to some extent. Alcohol is a CNS depressant, but nicotine is a CNS stimulant. These opposing mechanisms on a healthy, fully developed adult produce long-ranging and serious health consequences. Their research project aims to understand this mechanism on a growing fetal brain and determine if the effects are as detrimental or worse than in an adult.

Yilun Wang, an M2 at the Texas A&M College of Medicine, is conducting a clinical research project under the guidance of Dr. Michael Hofkamp, MD, Director of Obstetric Anesthesia at Baylor Scott & White Health and Clinical Associate Professor of Anesthesiology at Texas A&M College of Medicine. Postoperative analgesia for total joint arthroplasty can be accomplished with intra- articular injection of local anesthetic. Small studies have examined the pharmacokinetics of intra-articular local anesthetic injections and demonstrated that subjects did not have toxic levels of local anesthetics. However, larger retrospective and prospective studies have not been conducted to determine the incidence of local anesthetic precipitating systemic toxicity for subjects who have intra-articular injections of local anesthetics. Furthermore, the incidence of less obvious manifestations of systemic toxicities such as altered mental status and muscle rigidity following intra-articular injection of local anesthesia has not been studied. In Spring 2021, an educational initiative and in-service presentation was started to raise awareness of local anesthetic-initiated systemic toxicity following intra-articular injection to perioperative nursing staff at Baylor Scott & White Medical Center - Temple. The primary aim of this study is to determine the incidence of systemic toxicity from local anesthetic in intra-articular injection during total knee and hip arthroplasty through retrospective data collection and statistical analysis of patient data.

Alyson Win is an M2 Student conducting clinical research under the guidance of Dr. Michael Hofkamp, M.D. an anesthesiologist at Baylor Scott and White Medical Center, Temple. They are investigating the incidence of failed airway management for cesarean deliveries under general anesthesia. While regional anesthesia is preferred in cesarean section deliveries, general anesthesia can be used when indicated. However, one of the major concerns with general anesthesia is the inability to intubate or ventilate a patient. The incidence for failed airway induction in this patient population is currently estimated to be 1 in 500. Additionally, video laryngoscopes have been increasingly used as a safer approach to secure airways in cesarean section patients under general anesthesia. We propose a retrospective observational study to examine cesarean section deliveries performed under general anesthesia at Baylor Scott and White- Temple between  7- year period (February 1, 2014 and January 1, 2021). Our primary aim will be to determine the incidence of failed airway management for cesarean section deliveries performed under general anesthesia. Our secondary aim will be to compare the incidences of failed airway management between general anesthetics that used a video laryngoscope to general anesthetics that did not use a video laryngoscope.

Preston Adhikari, M2, and Sharon Pan, M2, students at the College of Medicine, are co-designing a clinical research project investigating risk factors associated with post-operative venous thromboembolism in spinal surgery under the guidance of L. Gerard Toussaint III, M.D., a licensed neurosurgeon at The Texas Brain and Spine Institute. Although venous thromboembolism (VTE) is a rare postoperative complication after spinal surgery, the fatality rate of pulmonary embolism, combined with the morbidity in patients who survive, make this severe adverse event a troubling concern of many spine surgeons. Predicting, in a community setting, those patients who are at highest risk would allow judicious pre-operative screening and a standardized approach to control for the postoperative VTE risk. Conclusions drawn from this study will alter clinical practice – those patients with risk factors we identify will be considered for pre-operative lower extremity ultrasounds, and more aggressive post-operative mitigation strategies. In addition, these identified patients could be a cohort to enroll in a prospective trial of a new management paradigm.

Lena Ayari, M2 student at the College of Medicine, is co-authoring a review article over super-refractory status epilepticus under the guidance of Batool Kirmani, MD, FAAN, FAES, Affiliated Clinical Professor at Texas A&M University College of Medicine and Director of the CHI St. Joseph Health Epilepsy and Functional Neurosurgery Program. Super-refractory status epilepticus (SRSE) is defined as status epilepticus that persists despite general anesthesia treatment for 24 hours. SRSE is a serious condition due to the high potential for morbidity and mortality, with a mortality rate between 30 and 50%. These patients are at risk for neuronal injury and death as a result of failure to terminate seizure activity. Their review concentrates on current therapeutic approaches for SRSE, the challenges and prognosis of this condition, as well as future directions for therapy.

Sonali Batta, M1 student at the College of Medicine, is conducting a research study investigating the changes in bowel morphology after spinal cord injury (SCI) in the laboratory of Cédric Geoffroy, PhD and Assistant Professor in the Department of Neuroscience and Experimental Therapeutics at the Texas A&M College of Medicine. The general term for clinicians, for decreased bowel functioning caused by neurological disease or injury is neurogenic bowel dysfunction (NBD). Remarkably, NBD is observed in up to ~60% of SCI individuals. SCI has been shown to induce NBD because the thoracolumbar region of the spinal cord and sacral nerves coordinate colonic reflexes through sympathetic, parasympathetic, and enteric neural circuits. The most debilitating symptoms observed in NBD patients include severely decreased fecal transit through the colon, fecal incontinence, and chronic constipation. Various factors are thought to influence the regulation and motility of the colon wall, such as collagen accumulation, muscle thickness, quantity of myenteric neurons, and colonic mucosal crypt depth. Thus, a thorough histological analysis is needed to understand the specific changes in bowel morphology in distinct SCI animal models. We predict that NBD changes may have consequences on nutrient absorption, amount of stool, hormone secretion, and other body functions controlled by the spinal cord nerves. We anticipate that our results may be used to guide the customization of more effective and direct therapies in patients that will promote overall peristalsis post-SCI.

Lokeshwar S. Bhenderu, M1 student in the College of Medicine, is conducting a research project investigating the teratogenic effects of concurrent exposure of alcohol and cannabinoids (CBs) on the developing fetus under the guidance of Rajesh Miranda, PhD, a Professor at Texas A&M College of Medicine. Prenatal exposure of alcohol and CBs can lead to abnormalities ranging from craniofacial dysmorphologies to brain malformations and intellectual disabilities. Therefore, the teratogenic effects of prenatal exposure to alcohol and CBs has been heavily investigated, but the vast majority of studies considered the consumption of alcohol and CBs independently. More recent epidemiological studies have shown that concurrent use of alcohol and CBs, colloquially termed ‘cross-fading’, during pregnancy is significantly high and continues to rise as more states legalize recreational marijuana. Their project aims to investigate the mechanism by which the co-abuse of CBs and alcohol during pregnancy effect fetal development.

Jared Eichner, M1 student in the College of Medicine, is conducting a research project investigating illustrated storytelling in medicine, under the guidance of Barbara Gastel, MD, MPH, Professor of Veterinary Integrative Biosciences and of Humanities in Medicine, and Coordinator, MS Program in Science and Technology Journalism. This project includes seeking medical examples in the work of Theodor Seuss Geisel (1904-1991). Findings to date include the following: Geisel worked as a political cartoonist, animator, and screenwriter, as well as being the author and illustrator of dozens of children’s books under the pen name Dr. Seuss. Additional books, some under other pseudonyms, were collaborations with other writers and/or illustrators. At least four examples of Geisel’s work related specifically to medicine. These include three items, all to train soldiers in malaria prevention, from Geisel’s work as a World War II Army captain. They also include You’re Only Old Once! A Book for Obsolete Children, which was released on Geisel’s 82nd birthday. In this book, a senior patient, perhaps a fictionalized Geisel, endures endless waits, an Eyesight and Solvency Test, and inspections by the doctors on Stethoscope Row. Regardless of whether his work falls within the strict definition of graphic medicine, Geisel has masterfully combined multiple comic images and text to tell medically relevant stories.

Uyioghosa Evbayiro, M2 student in the College of Medicine, is conducting a research project under the guidance of Rahul Srinivasan, PhD Assistant Professor in the Department of Neuroscience & Experimental Therapeutics at Texas A&M College of Medicine. Parkinson’s disease is a common progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta. Interestingly, S100 calcium-binding protein B (S100B), an astrocytic protein is significantly increased in the serum, CSF, and brain tissue of Parkinson’s patients compared to healthy control subjects. In addition, postmortem human midbrain tissue from Parkinson’s patients display elevated levels of S100B when compared to control subjects.1 Together, these data suggest that the secretion of S100B may be pathognomonic for Parkinson’s disease. Recent work in the lab has also shown that extracellularly secreted S100B alters the frequency of spontaneous calcium fluxes in dopaminergic neurons via voltage-gated calcium channels. This further suggests that S100B can induce dopaminergic neuron death by pathologically altering the pacemaking activity of dopaminergic neurons. Thus, understanding the mechanisms by which astrocytes secrete abnormal levels of S100B is critical for developing translatable neuroprotective drugs to treat early-stage Parkinson’s. The goal of this project is to determine the signal sequences in S100B that are responsible for its secretion. We will delete a putative secretion sequence from S100B and compare the extent to which the sequence governs extracellular S100B secretion using the transfection of plasmids, tissue culture, and western blot analysis. Identification of these signal sequences will be a critical step for understanding the molecular mechanisms regulating S100B secretion and is anticipated to give insight for the development of future therapeutics that potentially impede or significantly delay the progression of Parkinson’s disease.

1. Sathe K, Maetzler W, Lang JD, et al. S100B is increased in Parkinson's disease and ablation protects against MPTP-induced toxicity through the RAGE and TNF-α pathway. Brain (London, England: 1878). 2012;135(11):3336-3347. DOI: 10.1093/brain/aws250.

Clyde Fomunung, MBA a M2 student in the College of Medicine, is conducting a research project under the guidance of Jiang Chang, MD, PhD, FAPS, a Professor and Chancellor EDGES Fellow in the Center for Genomic and Precision Medicine, Institute of Biosciences and Technology (IBT). Their research focuses on investigating the use of a cutting-edge technology, 3-D dynamic Imaging (Vevo3100), in assessing cardiac function in both normal and heart failure mouse models. Over the years, the prevalence of heart failure with preserved ejection fraction (HFpEF) has continued to increase to approximately 50% of all heart failure diagnoses in the U.S. Despite numerous efforts, little progress has been made towards improving the prognosis of patients with this diagnosis. Treatment options for HFpEF are limited but mainly include reducing systolic blood pressure below 120 mmHg through the use of diuretics. Early detection is critical towards prognosis and their research aims to assess whether certain cardiac diseases, especially HFpEF, can be detected at an earlier onset using a sensitive 3-D Imaging System

Jordan Han, M1 student at the College of Medicine, is conducting a retrospective study in the lab of Farida Sohrabji, PhD, Regents Professor and Interim Head of the Department of Neuroscience and Experimental Therapeutics at the Texas A&M College of Medicine. This study will investigate the risk of stroke in breast cancer patients treated with Tamoxifen and Letrozole adjuvant therapies, which are widely used adjuvants in breast cancer therapy. In recent studies, it has been shown that breast cancer patients are at increased risk for cardiovascular accidents before and after cancer treatment, but it is not clear whether it is due to the cancer itself, or the cancer treatments. Estrogen is believed to be a cardio- and neuroprotective factor in young women and Tamoxifen and Letrozole disrupt estrogen synthesis and estrogen signaling, suggesting a possible mechanism by which these therapies may increase cerebrovascular accidents. This study will examine their incidence of cerebrovascular accidents specifically within the breast cancer victim population and is expected to shed light on the impact of standard chemotherapies on stroke risk.

Jeremiah Ling, M1 student in the College of Medicine, is conducting a research project under the guidance of Mark Faries, PhD, an Associate Professor at the Texas A&M AgriLife Extension Service. Their research focuses on the important role that lifestyle plays in patient health, and the physician-patient relationship. They hypothesize that what we eat, how we live, and the factors that influence lifestyle are critical for patient health outcomes. Their project focuses on the opinions that patients and healthcare providers hold in regards to what constitutes a “healthy” diet, and the availability and likelihood of healthy eating habits. With chronic disease on the rise, constituting the greatest health burden to most industrialized nations, the importance of analyzing diet habits is a first step in generating population changes in lifestyle. We will survey study participants about their opinions on healthy eating, the financial cost of eating healthy diets, and other barriers. This survey will be administered prior to a training that will aim to equip and debunk stereotypes that impede healthy eating. Following this training, a second survey will be administered to measure the efficacy of training exposure. Our project is anticipated to help change the eating habits paradigms, and thereby reduce the burden of preventable chronic diseases such as Type II diabetes, morbid obesity and others.

Peter Park, M1 student in the College of Medicine, is co-writing a scholarly manuscript for peer-review under the guidance of Pooneh Bagher, PhD, Assistant Professor in the Department of Medical Physiology at Texas A&M College of Medicine. Their study focuses on how the sympathetic nervous system modulate arteriolar tone through release of neurotransmitters such as norepinephrine and ATP, which act on adrenergic and purinergic receptors, respectively. Recognition of subtle differences in the adrenergic and purinergic signaling pathways of two common wild-type rodent strains reveals a knowledge gap on the signaling pathways involved in the normal physiology of isolated human mesenteric arteries. Detailed comparison of the mice and rat animal models studied here will inform the best model to use in future studies for human mesenteric pathology and other cardiovascular diseases.

Caren Stuebe, M1 student in the College of Medicine, is designing a clinical research project investigating adverse outcomes in cauda equina syndrome under the guidance of Gerard Toussaint, MD, an Assistant Professor at Texas A&M College of Medicine and Licensed Neurosurgeon at The Texas Brain and Spine Institute. Cauda equina syndrome is a surgical emergency caused by a compression of the cauda equina in the lumbosacral spinal canal. Untreated, cauda equina syndrome can result in muscle paralysis in the lower extremities and fecal and urinary incontinence. Emergency surgical treatment for cauda equina syndrome involves a full laminectomy and discectomy, both common treatment surgeries for lumbar stenosis and radiculopathy, respectively. Their research project aims to investigate complications from these surgeries in application to cauda equina syndrome.

Sara Yasrebi, M2 student in the College of Mecicine, participated in a research project in Lifestyle Medicine to query a physician’s role to improve patient health by referring to community-based nutrition education, under the guidance of Mark D. Faries, PhD, Associate Professor at the Texas A&M AgriLife Extension Service, and Adjunct Faculty within the Health Science Center. Dietary risks are the leading risk factor for premature death in the United States, with greater disparities in low-income and rural families without adequate access to quality healthcare and quality, nutritional education. Lifestyle Medicine is the evidence-based, lifestyle therapeutic approach to prevent, treat and reverse lifestyle-related disease. While physicians might feel that nutritional counseling is within the realm of their care, many have barriers to implement nutrition-based education in practice, and depend on community-based, nutrition education programs designed for at-risk populations. The objectives of this study were to (1) identify a physician's ability to locate community nutrition education programs, and (2) identify which programs could positively impact the health care outcome of their patients. Our findings showed that while certain key words yielded a higher proportion of relevant results, the proportion of pertinent nutrition programs found within the first 10 results were low. The phrases with the largest proportion of results within the first 2 pages (> 75%) were “community education nutrition programs low-income” and “diet nutrition education programs low-income Texas”. The addition of “low-income” to the search phrase produce a more data, while the addition of “rural” or “programs” were not helpful. These findings reinforce the idea that a strategically-phrased Google-search and proper evaluation of such results poses a short-term fix to the high-demand and low-supply of formally-educated nutrition advising by physicians.