Auburn Research Day 2022

Via Research Recognition Day Fi f th A nnua l

Feb. 18, 2022

Welcome

T he Edward Via College of Osteopathic Medicine (VCOM)-Auburn campus is hosting the fifth annual VCOM-Auburn Via Research Recognition Day. Via Research Recognition Day is a significant event for VCOM that supports the mission of the College to provide medical education and research that prepares globally-minded, community-focused physicians and improves the health of those most in need. Started in 2018, this annual event on the VCOM- Auburn campus provides a full day of activities focused on medical research. Via Research Recognition Day offers a forum for health professionals and scientists in academic institutions, teaching hospitals and practice sites to present and benefit from new research innovations and programs intended to improve the health of all humans. By attending the sessions with the speakers, participants have the opportunity to learn cutting edge information in the physiological bases of osteopathic manipulative therapy efficacy, new trends in physician-based research networks and how to develop innovative research projects with high impact for human health. Poster sessions allow participants to learn about the biomedical, clinical and educational research activities at VCOM-Auburn and its partner institutions.

Contents

Agenda �������������������������������������������������������������� 5 Keynote Speaker ���������������������������������������������� 7 Biomedical Research Abstracts 5 �����������������������������������������������������������������������10 7 �����������������������������������������������������������������������11 10 ����������������������������������������������������������������������12 14 ����������������������������������������������������������������������13 15 & 16 ��������������������������������������������������������������14 23 & 25 �������������������������������������������������������������18 38 & 39 ������������������������������������������������������������ 24 42 ��������������������������������������������������������������������� 26 44 �������������������������������������������������������������������� 27 46 & 47 ������������������������������������������������������������ 28 49 �������������������������������������������������������������������� 29 50 & 51 ������������������������������������������������������������ 30 53 �������������������������������������������������������������������� 31 55 �������������������������������������������������������������������� 32 58 & 59 ������������������������������������������������������������ 34 63 & 64 ������������������������������������������������������������ 37 65 �������������������������������������������������������������������� 38 66 �������������������������������������������������������������������� 39 67 �������������������������������������������������������������������� 40 70 ����������������������������������������������������������������������41 71 ��������������������������������������������������������������������� 42 73 & 74 ������������������������������������������������������������ 43 79 �������������������������������������������������������������������� 45 80 �������������������������������������������������������������������� 46 Clinical Case Report Abstracts 2 ������������������������������������������������������������������������ 8 3 & 4 ������������������������������������������������������������������ 9 6 �����������������������������������������������������������������������10 9 & 11 ���������������������������������������������������������������12 12 & 13 ��������������������������������������������������������������13 18 ����������������������������������������������������������������������15 21 & 22 �������������������������������������������������������������17 24 ����������������������������������������������������������������������18 28 ���������������������������������������������������������������������19

Clinical Case Report Abstracts (Cont.) 40 & 41 ������������������������������������������������������������ 25 43 �������������������������������������������������������������������� 26 45 �������������������������������������������������������������������� 27 54 �������������������������������������������������������������������� 32 62 �������������������������������������������������������������������� 36 75 & 76 ������������������������������������������������������������ 44 78 ��������������������������������������������������������������������� 45 Clinical Research Abstracts 1 ������������������������������������������������������������������������ 8 8 �����������������������������������������������������������������������11 17 ����������������������������������������������������������������������15 20 ���������������������������������������������������������������������16 27 ���������������������������������������������������������������������19 29 & 30 ������������������������������������������������������������� 20 31 & 32 ������������������������������������������������������������ 21 34 �������������������������������������������������������������������� 22 37 ��������������������������������������������������������������������� 23 48 �������������������������������������������������������������������� 29 56 & 57 ������������������������������������������������������������ 33 60 & 61 ������������������������������������������������������������ 35 68 �������������������������������������������������������������������� 40 69 ���������������������������������������������������������������������41 Educational Research Abstracts 26 ���������������������������������������������������������������������19 33 �������������������������������������������������������������������� 22 36 �������������������������������������������������������������������� 23 72 ��������������������������������������������������������������������� 42 Simulation Research Abstracts 19 ����������������������������������������������������������������������16 35 �������������������������������������������������������������������� 22 77 �������������������������������������������������������������������� 44

Notes ���������������������������������������������������������������� 48

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Via Research Recognition Day Fi f th A nnua l

Feb. 18, 2022

Agenda

8:00 – 9:00 a.m.

Registration Opens — First Floor Hallway

9:00 – 12:00 p.m.

Open Poster Session and Poster Competition Judging

12:00 – 12:30 p.m.

Break

Afternoon session will be live in Lecture Hall #1 and virtual in Lecture Hall #2

12:30 p.m.

Introduction Moderator – Dr. Kenny V. Brock, DVM, MS, PhD

12:35 – 12:45 p.m.

The State of Research at the Edward Via College of Osteopathic Medicine Plenary Lecturer – P. Gunnar Brolinson, DO, FAOASM, FAAFP, FACOFP

12:45 – 1:30 p.m.

Fatigue Failure: A Causal Mechanism for Musculoskeletal Injuries? Keynote Speaker – Sean Gallagher, PhD, CPE, FAIHA

1:30 – 1:45 p.m.

Flourishing in Swallowing Science Speaker – William G. Pearson, PhD

1:45 – 2:00 p.m.

Health Homemade Speaker – Annie Kirby, PhD, RD

2:00 – 2:30 p.m.

My Personal Research Journey Speaker – Dr. Michael D. Goodlett, MD, FAAFP

2:30 – 3:00 p.m.

Two Highways Lay Before Me: Which One Will I Choose? Speaker – Dr. Kenny V. Brock, DVM, MS, PhD

3:00 p.m.

Poster Competition Awards, Closing Remarks and Adjournment

6

Keynote Speaker

Sean Gallagher, PhD, CPE, FAIHA

S ean Gallagher, PhD, is the Hal N. and Peggy S. Pennington Professor in the Department of Industrial Engineering within the Auburn University Samuel Ginn College of Engineering. Gallagher earned a BA in Music from the University of North Carolina- Chapel Hill and an MS in Physical Education from Pennsylvania State University. He earned a PhD in Industrial and Systems Engineering from Ohio State University. Gallagher has worked in the Ergonomics field for 37 years, working for the U.S. Bureau of Mines, the National Institute for Occupational Safety and Health and currently Auburn University. Gallagher is a Certified Professional Ergonomist. He is a Fellow of both the Human Factors and Ergonomics Society and the American Industrial Hygiene Association. Gallagher is a two-time recipient of the International Ergonomics Association/Liberty Mutual Medal in Occupational Safety and Ergonomics (2013 and 2018), and a recipient of the Ergonomics Journal Best Paper Award (2021). His research interests include musculoskeletal disorder etiology, ergonomics and work physiology.

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2022 Via Research Recognit ion Day

Alexandra C. Skoczek, MPH 1 , OMS-II; Patrick W. Ruane, OMS-II 2 ; Cassidy A. Onley, OMS-II 3 ; Torhiana Haydel, MHA, OMS-II 4 ; Maria V. Ortega, OMS-II 4 ; Alexis M. Stoner, PhD, MPH 2 ; H. Dean Sutphin, PhD 3 VCOM – Auburn 1 ; VCOM – Carolinas 2 ; VCOM – Virginia 3 ; VCOM – LA 4 Cl i n i ca l Resea rch | Med i ca l St udent Testimonials from Multinational Medical School Students in the Face of the Covid-19 Pandemic: A Global Health Approach 1

In the midst of the Covid-19 pandemic, countries, and governments around the world have implemented different measures and guidelines for the containment and mitigation of the SARS-CoV-2 virus. In addition to implemented policies and initiatives, social media and personal beliefs have affected medical students’ social, emotional, financial, and academic success both domestically and internationally. As osteopathic medical students focused on the interconnectedness of the mind, body, and spirit, we questioned the impact of the pandemic and global responses on the beliefs and psychological well-being of medical students around the world. Due to differences in global response and media portrayal, it was hypothesized that, international medical students in countries such as El Salvador, Honduras, and the Dominican Republic will be impacted differently regarding Covid-19 policy strictness, social and mental health, financial and academic stability, and overall attitude towards the pandemic than the US medical students. In this prospective qualitative study, United States and international medical students enrolled in the Global Seminar for Health and Environment course were eligible to participate in the study. Participants completed a weekly, non-graded journaling assignment for six weeks that asked open-ended questions about personal beliefs and knowledge, policies and initiatives, global policies and initiatives, and social media presentations. A qualitative thematic analysis was then performed.

International medical students believed that their country's COVID-19 response contained more restrictions than the global response, with the theme being expressed in 17% compared to 1.7% of US responses containing the theme. International students were also more likely to express views on negative mental health impacts as well as economic impacts. The theme “mental health impact” was present in 27.3% of international responses and included responses such as: "My anxiety and panic have risen to such levels that it is hard for me to tolerate casual touch and proximity. I don't remember the last time I hugged a friend." The U.S. responses showed less of a mental health impact and expressed stronger negative views on how COVID-19 was handled in regard to policies and initiatives. While it was not a major theme expressed, the U.S. responses also contained more criticism of the political response to Covid-19. The current study was limited by responses and student participation each week. Future studies aimed at analyzing specific Covid-19 policies around the world and the extent of the pandemic’s impact on mental health may provide greater insight into medical students' beliefs, attitudes, and well-being which have been challenged over the last year. Regardless, it must be acknowledged that the medical school experience has changed for both international and the United States medical students and affected them not only academically but mentally, socially, and financially.

Cl i n i ca l Case Repor t | Med i ca l St udent Pneumatocele-Induced Pneumothorax in a Patient with Post-Covid-19 Pneumonitis: A Case Report

2

Kevin O. Wortman II, MS, OMS-IV; Kevin O. Wortman Sr., CCRN, BSN Edward Via College of Osteopathic Medicine-Auburn; Florida Agriculture and Mechanical University

Background: The COVID-19 pandemic has been challenging medical professionals and facilities for over a year now. Much of the literature describes pathologic lung changes and complications associated with SARS-CoV-2, with pneumothorax and pneumatoceles not being uncommon. The Case: We describe a case involving a patient that presented to the emergency department with a pneumothorax. Three weeks prior, the patient was hospitalized for 10 days in acute respiratory distress secondary to SARS-CoV-2 pneumonia, which did not require ventilator support. Follow up imaging revealed a 7 cm (AP) x 4.6 cm (transverse) x 2.5 (cc) cm pneumatocele.

Conclusion: We speculate that antecedent rupture of an unrecognized pneumatocele likely caused lung collapse leading to the patient’s pneumothorax. Therefore, we recommend that patients with post-COVID-19 pneumonitis, especially those given ventilator support, are assessed radiographically before hospital discharge and within two weeks after discharge to discern whether the patient may be at risk for multiple pathological pulmonary events after COVID-19 hospitalization.

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Cl i n i ca l Case Repor t | Med i ca l St udent Ebv-Associated Nasopharyngeal Carcinoma in a Caucasion Male Smoker: A Case Report

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Julian Aguilar, OMS III; Kenneth Appel, OMS III; Cristina Negoescu, OMS III; Chinyere C. Mbaeri, MD VCOM – Auburn Campus; Wellington Regional Medical Center, Wellington, FL

Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma is a malignancy of squamous origin with distinct distribution in Northern Africa and Southeast Asia. It is particularly uncommon in the United States. We report a case of a 50-year-old Caucasian male with a long-standing history of tobacco use that presented with a left sided neck mass. CT scan of the neck showed a 3.8 cm enhancing mass or node in the left side of neck and a 2.4 cm soft tissue density mass in the cavernous sinus on the right. MRI of the face/ neck/orbit with and without contrast showed an enlarged lymph node just posterior to the left submandibular gland measuring approximately 2.4 x 1.8 cm, a large posterior cervical triangle nodal mass measuring 2.7 x 3.2 cm, and mild right sided adenopathy not

as prominent as on the left. Left nasopharyngeal mass biopsies and fine needle aspiration of the left sided neck mass were all consistent with squamous cell carcinoma. Immunohistochemistry stains revealed cytokeratin AE1/AE3, p63, HLA-DR, CK56, and EBV were all positive in the neoplastic epithelial cells, supporting the diagnosis of nonkeratinizing nasopharyngeal carcinoma. In situ hybridization analysis resulted in HPV negative and EBV positive testing. Patient has completed three cycles of induction chemotherapy followed by concurrent chemoradiation as well as nine weeks of radiation. This case report demonstrates the possibility of an uncommon malignancy presenting in a patient of differing demographics than those typically affected.

4 Nosha Farhadfar; Raad Z. Gharaibeh; Wendy J. Dahl; Lacey Mead; Michael Weaver; Zeina Al-Mansour; Christian Jobin; Debra Lyon; John R. Wingard; Debra Lynch Kelly Department of Medicine, Division of Hematology & Oncology, University of Florida; (2) Department of Medicine, Division of Gastroenterology, University of Florida; (3) Food Science and Human Nutrition, University of Florida; (4) College of Nursing, University of Florida Cl i n i ca l Case Repor t | Med i ca l St udent Gut Microbiota Dysbiosis and Persistent Fatigue in Hematopoietic Cell Transplant Survivors

Introduction: Fatigue is a prevalent and distressing complication among hematopoietic stem cell transplant (HCT) survivors, negatively affecting physical, social, and emotional quality of life domains. Evidence links chronic inflammation to alterations in nervous system activity and distressing symptoms such as fatigue. Gut mucosa damage due to alteration in gut microbiota (GM) and microbial translocation likely increase systemic pro-inflammatory cytokines. The aim of this study was to evaluate the relationship between GM and persistent fatigue post HCT. Methods: This study included 30 adults who had HCT for a hematologic disease and were at least one-year post-HCT. Patients with chronic GVHD were excluded. Fatigue was assessed using the Brief Fatigue Inventory (BFI). A cut-off score of four for fatigue on a scale of 0-10 was used to indicate clinically significant fatigue. Patients were grouped into two categories: BFI 0–3 (without fatigue) and BFI ≥ 4 (with fatigue). The V1-V3 region of the 16S rRNA gene from fecal specimens was sequenced using Illumina MiSeq. Sequencing reads were processed, dereplicated, chimeras filtered, amplicon sequence variants (ASVs) generated and assigned taxonomy using DADA2. Beta diversity analysis through Principal Coordinate Analysis (PCoA) was generated using Bray-Curtis dissimilarity matrix and the difference was tested using linear model with generalized least squares (gls) in R. Alpha diversity analysis was done using Chao1. Linear discriminant analysis effect size (LEfSe) was used to find markers that differentiate between the two groups.

Results: Patient were categorized into two cohorts; 1) with fatigue (n= 14) 2) without fatigue (n=16). The two cohorts were similar in demographic, disease, or transplant (Table 1). There was a significant difference in GM composition (beta diversity) between the two cohorts (Figure A, P = 0.001). Alpha diversity (richness) was also significantly lower in survivors with fatigue (Figure B, P =0.002). LEfSe analysis identified 46 discriminative features (p< 0.05, LDA score >2) whose relative abundance varied significantly among individuals with and without fatigue. Ten ASVs were associated with fatigue and 36 ASVs were associated with those without fatigue. Several ASVs enriched in survivors with fatigue included organisms such as Klebsiella and Enterococcus, which have been implicated in inflammatory bowel diseases. The ASVs enriched in the cohort without fatigue were members of the Ruminococcaceae family (Oscillospira spp) and Lachnospiraceae family (Fusicatenibacter, Coprococcus spp) which are known to have the ability to ferment complex plant carbohydrates. Conclusion: These findings show an association between GM composition and fatigue and suggest a microbial contribution to clinically significant fatigue post-HCT which may guide new approaches for treatment of fatigue based on GM manipulation.

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2022 Via Research Recognit ion Day

Mason C McIntosh; Casey L. Sexton; Joshua S. Godwin; Bradley A. Ruple; Shelby C. Osburn; Blake R. Hollingsworth; Philip J. Agostinelli; Andreas N. Kavazis; C. Brooks Mobley; Tim N. Ziegenfuss; Hector L. Lopez; Varun B. Dwaraka; Ryan Smith; Kaelin C. Young, PhD; Michael D. Roberts Auburn University; The Center for Applied Health Sciences, Canfield, OH; TruDiagnostic, Lexington, KY; Edward Via College of Osteopathic Medicine-Auburn Campus B i omed i ca l Resea rch | Med i ca l St udent Effects Of Different Types Of Resistance Exercise Failure Training On The Methylation Status Of Genes That Drive Skeletal Muscle Hypertrophy 5

Objective: We sought to determine how one bout of resistance training to failure with either higher repetitions (30FAIL) or lower repetitions (80FAIL) affected the promoter methylation statuses of genes that drive skeletal muscle hypertrophy. Hypotheses: We hypothesized that a bout of 80FAIL training would lead to a more robust hypomethylation of genes that regulate skeletal muscle hypertrophy compared to 30FAIL training. Methods: Eleven previously-trained college-aged men (age: 23 ± 4 years, 11.42 ± 6.38 percent fat, 4 ± 3 years training experience) volunteered for this study. Each participant underwent two training bouts (spaced one week apart) involving either: i) 30FAIL training; 4 sets of back squats and 4 sets of leg extensors to failure at 30% of one-repetition maximum (1RM), or: ii) 80FAIL training; 4 sets of both exercises at 80% of 1RM. Muscle biopsies from the vastus lateralis were collected prior to each bout (PRE), 3 hours following each bout (3hPOST), and 6 hours following each bout (6hPOST). Following the conclusion of the study, tissue was batch-processed for DNA isolation, and DNA was subjected to the Illumina MethylationEPIC array. In an a priori fashion, genes that have been shown to induce skeletal muscle hypertrophy in genetic mouse models were the target of this investigation (Verbrugge et al. Frontiers Physiol, 2019).

Results: Total training volume (sets x reps x load) between the 30FAIL and 80FAIL bouts were not significantly different (p= 0.571). Differentially methylated region changes for the following genes from PRE to 3hPOST and PRE to 6hPOST are presented herein: SKI, FST, AKT1, ACVR2B, MSTN, KLF10, RHEB, IGF1, PAPPA, PPARD, IKBKB, FSTL3, ATGR1, UCN3, MCU, JUNB, NCOR1, GPRASP1, GRB10, MMP9, DGKZ, PPARGC1A, SMAD4, LTBP4, BMPR1A, CRTC2, XIAP, DGAT1, THRA, ADRB2, ASB15, CAST, EIF2B5, BDKRB2, TPT1, NR3C1, NR4A1, GNAS, PLD1, CRYM, CAMKK1, YAP1, INHBA, TP53INP2, INHBB, NOL3, and ESR1. Additionally, significant differences between conditions at each time point are highlighted. Conclusions: This study continues to display how different modalities of resistance training affect the skeletal muscle molecular milieu and furthers our scientific understanding of factors that contribute to training adaptations.

Cl i n i ca l Case Repor t | Med i ca l St udent Abnormal Presentation of Multiple Myeloma in Pregnancy

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Robert Chory OMS III; Kiveum Kim OMS III; Ryan Cone OMS III; Joshua Hollingsworth PhD, PharmD; Rowell Ashford, MD VCOM-Auburn Campus, Princeton Baptist Medical Center

Multiple myeloma is a malignancy with an estimated prevalence in the United States of 1 in 132 (0.76%). The condition is three times more common in African-American populations when compared to Caucasians, and is classically a disease of the elderly, with only 10% of cases being diagnosed before age 50. The only known risk factors for MM are high BMI, family history of MM and exposure to agent orange in patients with Monoclonal Gammopathy of Unknown Significance. Classic presentation of multiple myeloma in the general population includes lytic bone lesions, elevated calcium levels, renal injury, and a normochromic, normocytic anemia which was the most common finding. Here we report a rare case of multiple myeloma in a 43-year-old African American woman at 24 weeks gestation, who presented for severe flank pain and difficulty breathing. Lytic bone lesions, anemia, and elevated total protein were noted and an iliac crest

biopsy confirmed the diagnosis of MM. She was started on steroids at 27 weeks gestation and delivered via caesarian-section at 30 weeks gestation. Postpartum, a treatment regimen to allow for breast-feeding was discussed but unable to be accommodated, and she was started on a multi drug chemotherapy regimen. There have only been about 30 cases of multiple myeloma in pregnant women reported in the literature. The rarity and lack of information on the effects of multiple myeloma in pregnancy was the primary indication for publication of this case.

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Shelby C. Osburn, Paulo H.C. Mesquita, Frances K. Neal, Bradley A. Ruple, Matthew T. Holmes, Michael D. Roberts Auburn University, School of Kinesiology 7 B i omed i ca l Resea rch | Gr adua te/Undergr adua te St udent Skeletal Muscle Line-1 Gene Regulation and Inflammatory Response to Chronic, Voluntary Endurance Training in Rodents

Objective: We sought to determine the effects of chronic, voluntary wheel running on Long Interspersed Nuclear Element-1 (LINE-1) mRNA expression and promoter methylation, as well as markers of the cGAS-STING inflammatory pathway, in skeletal muscle. Hypotheses: LINE-1 mRNA expression will increase with age, and exercise will mitigate this increase. This difference in expression will be driven through changes in promoter methylation. The cGAS- STING inflammatory pathway will be upregulated with age and downregulated with rats that exercise-trained. Methods: Plantaris and soleus skeletal muscles were collected from female Lewis rats that belonged to one of three groups: a young control group (CTL; n=10; 6 mos old), an aged sedentary group (SED; n=12; 15 mos old), and an aged exercise group with access to a running wheel for 9 months (EX; n=12; 15 mos old). RNA, DNA, and protein were isolated from the tissues for analysis. Analysis included RT-qPCR for LINE-1 mRNA expression, methylated DNA Immunoprecipitation (MeDIP) to assess the methylation status of the LINE-1 promoter via RT-qPCR, and Western blotting for markers of the cGAS-STING pathway and 4Hydroxynonenal (4HNE). Two primer sets were used for RT-qPCR: L1-3 probed for the most active form of LINE-1 and L1-Tot probed for all full-length LINE-1 elements.

Results: There was no significant difference in plantaris LINE-1 mRNA expression or for L1-3 or L1-Tot. Plantaris LINE-1 promoter methylation was undetectable in most samples, so the results are not presented herein. Soleus L1-3 mRNA was significantly higher in EX compared to CTL (p=0.036) and there was a trend between SED and EX (p=0.053). L1-Tot also was trending (p=0.059), where EX was higher than CTL (p=0.025). Methylation of the LINE-1 promoter was significantly different for both L1-3 and L1-Tot (p=0.021 and p=0.028, respectively). In both instances, LINE-1 DNA in SED and EX were significantly more methylated compared to CTL. There were no differences in cGAS protein expression, p-/pan STING protein expression, or 4HNE expression. Conclusions: Contrary to the original hypothesis, LINE-1 mRNA expression and DNA methylation were higher in the exercise group. Additionally, chronic exercise did not affect the cGAS-STING inflammatory pathway, highlighting this pathway may be more relevant in extreme age and disease states. Previous skeletal muscle research has focused on using mixed muscle types to look at LINE-1 expression and regulation, so the differences seen between type I (soleus) and type II (plantaris) fibers is a novel finding that warrants further investigation to understand the underlying mechanisms.

Cl i n i ca l Resea rch | Med i ca l St udent Clinical Outcomes of Behavioral Activation Therapy: Actigraphy and Mood

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Nora Rady, OMS I; Susannah Murphy, PhD VCOM-Louisiana Campus; Psychopharmacology and Emotion Research Laboratory, Department of Psychiatry, University of Oxford, United Kingdom

Objective: Behavioral Activation therapy (BA) is an effective treatment for depression and relies upon the practice of increasing engagement in activities promoting positive mood. The mechanism by which BA works to improve mood is not well understood. The study uses an objective measure of activity (actigraphy) to investigate whether BA increases motor activity and whether this is related to clinical improvements in mood. The study included an active control group, which allowed the isolation of the key active ingredients of the intervention in order to provide a mechanistic account of the role of daily activity in the clinical effects of BA. Methods: The study consisted of sixty-five participants each allocated to one of three groups. Those in the BA and active control groups underwent a 4-week intervention (divided into 3 blocks) of either BA or an “Activity Monitoring” intervention respectively while those in the control group received no intervention. Results: Both the BA and active control group displayed an improvement in mood via the Behavioral Activation for Depression (BADS) score and decrease in depression symptomology at the end of the study, while the control displayed no change. However, only

the BA group displayed an increase in diurnal motor activity (M10) while the active control and control groups displayed no change in M10. The BA group displayed an association between M10 and level of mood (p=.005, r=.45). Conclusion: An increase in diurnal motor activity may be a key moderator of the effect of BA on mood. Note: The entire study is from the University of Oxford and has been ongoing since 2018, it is a PhD student's study and I was part of both data collection and analysis during my time at the University of Oxford. My poster represents a subset of the data that was collected and analyzed by me however, the study was still ongoing up until recently (data collection ended September 2021). Since then and during this winter break (2021) I was assisting the PhD student with troubleshooting in her analysis of the data but I am not currently a part of the study since I graduated in November 2020. The data that I submitted in my abstract was my own work and I was really hoping to be able to present it at the student forum.

11 2022 Via Research Recognit ion Day

1 Jordan Wordekemper, OMS III; 2 Kenneth Sigman, MD 1 Edward Via College of Osteopathic Medicine-Auburn Campus; 2 Grandview Medical Center, Birmingham AL Cl i n i ca l Case Repor t | Med i ca l St udent Intraductal Papillary Mucinous Neoplasm Disguised as Pyrosis and Hyperglycemia: A Case Report 9

Intraductal papillary mucinous neoplasms (IPMN) are increasing in incidence due to more frequent imaging. While most tumors are asymptomatic, some may present with vague gastrointestinal symptoms and laboratory findings. Our patient presented to the emergency room with a history of abdominal pain, vomiting, diarrhea, and a “burning” upper epigastric pain. Evaluation was

significant for elevated AST, ALT, and glucose with a CA19-9 of 62.2. Imaging and pathology were suggestive of pancreatic malignancy. As with our patient, clinical suspicion should remain high when older individuals present with new onset diabetes and GI unrest which should warrant further evaluation.

B i omed i ca l Resea rch | Med i ca l St udent Incidence And Significance Of Heavy Metals In Rice

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Tracee Guthrie, OMS II; Brooke Benjamin, OMS II; Erin Collins, OMS II; Gurleen Kaur, OMS II; James Palmieri, PhD VCOM-Auburn campus; KYCOM; VCOM-Carolinas campus; VCOM-Virginia campus; VCOM-Virginia campus

Heavy metals in particular cadmium, arsenic, and lead have developed into a prominent topic as potential sources of toxicity. This article aims to highlight the key aspects of exposure, distribution, and metabolism of arsenic, cadmium, and lead with an emphasis on rice as a source of exposure. The rice analyzed showed significant levels of all three heavy metals sourced from the USA, China, Thailand and India. Rice samples highest in arsenic were from the USA, samples highest in lead and cadmium were from

China. Analysis revealed a great necessity for further research to demonstrate the importance for public awareness and education for prevention of exposure to heavy metals via rice ingestion. Research deems it is necessary to increase regulations of environmental pollutants to decrease risk of exposure, especially to vulnerable populations like pregnant and breastfeeding mothers.

Cl i n i ca l Case Repor t | Med i ca l St udent Pterygoideus Proprius with Bifid Condylar: An Anatomic Review Case Report

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There is limited understanding of the cause of trigeminal neuralgia, despite research over the years to identify its etiology. One common theory on this disease's cause is neurovascular compression due to a pathoanatomical phenomenon that puts the vessel and cranial nerve in an irritable state. Here we describe a rare case of an accessory muscle, along with an atypical shaping of the mandibular condyle, that may support this theory. During an educational dissection of an 87-year-old male cadaver, an accessory muscle identified as pterygoideus proprius (PP) and a bifid mandibular condylar (BMC) were identified unilaterally. The PP was situated between the superior and inferior heads of the lateral pterygoid Adam Nguyen, OMS-II, Justin Dover, OMS-II, Mary B Downs, PhD Edward Via College of Osteopathic Medicine-Auburn

muscle. Its fibers feed into the distal one-third of the inferior head of the lateral pterygoid muscle close to the right lateral pterygoid plate. The BMC, in this case, was of the mediolateral variation. The aberrant muscle described in this case could potentially impinge upon branches of V3 of the trigeminal nerve leading to trigeminal neuralgia. A deeper understanding of PP and bifid condylar variations is necessary when diagnosing trigeminal neuralgia.

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12 Dr. Matthew Johnson, MD, Co-Author; Collin R. Vargas, OMS III, Co-Author; Kenneth NW. Appel, OMS III, Co-Author Fort Walton Beach Medical Center, Fort Walton Beach, FL; VCOM – Auburn Campus Cl i n i ca l Case Repor t | Med i ca l St udent Rhabdomyolysis And Compartment Syndrome in the Setting of Amphetamine Overdose and Prolonged Imobilization

Background: An increase in illicit drug use and abuse has continued to plague the United States. It has been noted that young men around age 35 and younger have been one of the most impacted groups, with substance abuse more than doubling in this population over the past decade [2]. In this case, the patient was found to have compartment syndrome with concomitant rhabdomyolysis after having been found down due to ingesting an unknown amount of amphetamine. Cases like this continue to increase as drug abuse epidemic escalates. Methods: Detailed review of a multitude of cases, articles, studies regarding etiology, pathophysiology and clinical features of both rhabdomyolysis and compartment syndrome individually and in the setting of illicit drug use.

Results: Compartment syndrome may have an insidious onset when paired with illicit drug use. It has been shown that early recognition and identification of compartment syndrome can lead to improved outcomes for the patient. Conclusions: Physicians should give great consideration of compartment syndrome to patients found down post-illicit drug use in order to promptly identify and treat the condition and to prevent negative outcomes. Attention should be given to patients in this population who complain of pain and motor/sensory deficits.

Cl i n i ca l Case Repor t | Med i ca l St udent Hemothorax and Laceration of the Left Ventricle 13

Kenneth NW. Appel, OMSIII, Cristina N. Negoescu, OMSIII, Julian A. Aguilar, OMSIII, Alexys N. Ramos, OMSIII, Collin R. Vargas, OMSIII, (2) Dr. Matthew Johnson M.D. (preceptor) Edward Via College of Osteopathic Medicine – Auburn Campus; Fort Walton Beach Medical Center

A patient surviving a hemothorax with a laceration of the left ventricle is an extremely rare patient case and associated with a low in-hospital survival rate. Early recognition and implementation of life-sustaining measures is paramount to the survival of traumatic injuries, especially to the heart. This study details the case of a 16-year-old male who presented to the ER with a 6-cm penetrating laceration just above the left costal margin in the anterior axillary line. The patient was hypotensive, but alert and combative with wounds that suggested a massive hemothorax, with suspicion for cardiac, diaphragmatic and lung injury. Upon insertion of a left chest tube,

copious amounts of blood were obtained. The patient’s fast exam revealed a collection of pericardial fluid. The patient underwent an emergent sternotomy with a laparotomy and thoracotomy, which showed a laceration of the left ventricle and inferior lobe of the left lung. The patient was placed on cardiopulmonary bypass, the cardiac laceration was sutured, and the left lower lobe of the lung was partially resected. Two thoracostomy tubes and one mediastinal tube were placed, and the patient was admitted to the ICU for recovery.

Cristina M Gaudioso, MD; Adam Nguyen, MPH; Emmanuelle Waubant, MD; and Eoin P Flanagan, MBBCh Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO; Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Edward Via College of Osteopathic Medicine -Auburn Campus; UCSF Regional Pediatric MS Center, San Francisco, CA B i omed i ca l Resea rch | Med i ca l St udent Frequencies of AQP4 And Mog Antibodies Among Pediatrics with Multiple Sclerosis: A Case-Control Study 14

Objective: Using a prospective cohort we aimed to determine the frequency of myelin oligodendrocyte glycoprotein (MOG)-IgG and aquaporin-4 (AQP4)-IgG among pediatric-onset multiple sclerosis (POMS) patients and healthy controls, compare outcomes in seronegative vs seropositive children, and identify predictors of final diagnosis. Methods: POMS patients and healthy controls were enrolled at 14 U.S. sites through a prospective case-control study on POMS risk factors. Serum AQP4-IgG and MOG-IgG were assessed using live cell-based assays.

Results: We included 1196 participants, 493 POMS and 703 controls. AQP4-IgG was negative in all participants. MOG-IgG was positive in 30/493 cases (6%) and 0/703 (0%) controls. Twenty-five of 30 MOG-IgG positives (83%) had MOG-IgG-associated disease (MOGAD) while 5/30 (17%) maintained a diagnosis of MS on re- review of imaging and medical records. Conclusion: MOG-IgG and AQP4-IgG were not identified among controls confirming their high specificity for pediatric CNS demyelinating disease. Five percent of those with prior POMS diagnoses ultimately had MOGAD; none had AQP4-IgG positivity.

13 2022 Via Research Recognit ion Day

Kyra S. Lowery 1 ; Joshua S. Godwin 2 ; Abigail M. Bogard 1 ; Tyler M. Martinez 1 ; Michael D. Goodlett 1,3 ; Joseph L. Edison 1,3 ; Michael D. Roberts 1,2 ; Kaelin C. Young 1,2 1 Edward Via College of Osteopathic Medicine-Auburn Campus; 2 School of Kinesiology, Auburn University; 3 Athletics Department, Auburn University B i omed i ca l Resea rch | Med i ca l St udent Ultrasound Echo-Intensity Does Not Correlate With Peripheral Quantitative Computed Tomography Markers Of Skeletal Muscle Quality 15

Purpose: Ultrasound imaging of skeletal muscle has become a common non-invasive method for measuring changes in skeletal muscle size and composition. Echo-intensity from ultrasound imaging has become a popular marker for muscle quality, as a lower echo-intensity is believed to represent a higher amount of functional muscle tissue, while a higher echo-intensity represents greater amounts of adipose and connective tissue. The purpose of this study was to determine if ultrasound derived echo-intensity is a marker of changing muscle quality following resistance training by comparing echo-intensity to pQCT derived muscle density and intramuscular adipose tissue. Methods: 34 untrained college females (age; 21 ± 2.1, BMI; 23.37 ± 3.36) participated in 10 weeks of resistance training. Prior to the first training bout, and 72 hours following the last bout, all participants completed a series of scans in both pQCT and ultrasound. Ultrasonography images were obtained of the vastus lateralis of right leg in the sagittal plane with a b-mode imaging device (LOGIQ S7 Expert, GE Healthcare, USA). Settings were kept consistent across all participants (Depth: 5.0 cm, Frequency: 12MHz, Gain: 55 dB, Dynamic Range: 72) and the same technician performed all scans. Peripheral quantitative computed tomography (pQCT) was used to measure muscle density and intramuscular adipose tissue (IMAT). Cross-sectional images of the right thigh were obtained using a pQCT scanner (Stratec XCT 3000, Stratec Medical, Pforzheim, Germany) with single 2.4 mm slice thickness, voxel size of 0.4 mm

and scanning speed of 20 mm/sec. All scans were performed and analyzed by the same investigator. Test-retest reliability for ultrasound (ICC 3,1 = 0.996; SEM = 4.14; MD = 11.47 AU) and pQCT (ICC 3,1 = 0.99; SEM = 0.84 cm 2 ; MD = 2.32 cm 2 ) was previously determined. All images were analyzed using ImageJ software (version 1.51, National Institutes of Health). Statistics were performed in SPSS v26.0 (IBM Corp, Armonk, NY, USA). Paired samples t-tests were performed on all variables to compare pre to post changes and Pearson R correlation coefficients were used for determining correlations between echo- intensity and pQCT variables. All data are presented as mean ± standard deviation and significance level set at p < 0.05. Results: Following 10 weeks of resistance training, muscle density did not significantly change (-1.25 ± 0.68 mg/cm3, p = 0.077), IMAT significantly increased (+0.193 ± 0.056 cm2, p = 0.0018), and echo-intensity significantly decreased (-9.88 18.33 AU, p = 0.003). Using Pearson R correlation, echo-intensity did not correlate to muscle density or IMAT using change scores (r = -0.055, p = 0.750 and r = 0.149, p = 0.397; respectively) and percent change scores (r = -0.022, p = 0.901 and r = 0.192, p = 0.276; respectively). Conclusion: Given the findings in the current study, ultrasound derived echo- intensity should not be used as a measurement of muscle quality following resistance exercise training. Further investigation into ultrasound echo-intensity is needed to understand what echo- intensity represents physiologically with respect to muscle composition and quality.

B i omed i ca l Resea rch | Med i ca l St udent Covid-19 and Vitamin D: Is There A Direct Relationship Between Vitamin D Deficiency And Covid-19 Severity?

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Andrew J. Gonedes, OMSIII; and Gary Mount, PharmD VCOM-Auburn

COVID-19 Coronavirus disease is an ailment ravaging the world with multiple variant strains. The World Health Organization (WHO) renamed the 2019 nCoV to COVID-19, a disease characterized by pneumonia symptoms. It is thought the disease originated in Wuhan City in China (Shakoor et al., 2021). The airborne virus rapidly spread from its origin to other parts of the globe in record time due to the increased movement of people through road, rail, and air transport. According to Kumar et al. (2021), COVID-19 is characterized by lower respiratory tract viral infection with symptoms including oxidative stress that make it harder for patients to absorb an adequate amount of oxygen into the bloodstream (Slominski et al., 2021). Figure 1 is a diagrammatic representation of the COVID- 19 virus structure. The spike glycoprotein attaches to healthy cells, enter, multiply, and burst open to release the newly-created viruses. Slominski et al. (2021) define COVID-19 as a severe respiratory syndrome containing a positive RNA strain belonging to the Coroniridae family. The virus has a moderately low mortality rate, albeit several times more lethal than conventional influenza viral infections (Slominski et al., 2021).

Mansur et al. (2020) add that the COVID-19 virus "binds to ACE2 enzyme, making more angiotensin II available to cause damage" (p. 268). Thus, increased production of angiotensin II in the body fosters an attack on the respiratory system and makes the ailment more potent among infected patients. Vitamin D is one of the most valuable nutrients in the body and can be found on many food items and the sun's ultraviolet rays. Iddir et al. (2020) clarify that Vitamin D is present in eggs, mushrooms, fish, and fortified milk diets. However, the higher amount of functional Vitamin D comes from the sun's rays. In particular, the ultraviolet-B (UVB) is absorbed through the human skin and is responsible for reducing cytokine storms (Grant et al., 2020). Slominski et al. (2021) describe Vitamin D as a fat-soluble prohormone that plays an essential role in physiological functions in the body, such as the regulation of adaptive and innate immunity in the body. Therefore, Vitamin D is vital to fighting pathogens in the body. From this information, this study will investigate whether there is a credible relationship between Vitamin D in the body and the severity of COVID-19 among patients.

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(1) Vindhya Basetty, PharmD Student; (2) Jack Deruiter, PhD; (3) Suhrud Pathak, HORP Student; (4) Kamal Dua, PhD; (5) Muralikrishnan Dhanasekaran, PhD (1) HSOP – Auburn Campus; (2) University of Technology Sydney, NSW, Australia Cl i n i ca l Resea rch | Gr adua te/Undergr adua te St udent Advanced Drug Delivery Systems Targeting to Improve Therapeutic Outcomes in Porphyria 17

Porphyrias are known as disorders of the heme biosynthesis pathway. There are about eight metabolic disorders that make up the porphyrias. These eight metabolic disorders are porphyria cutanea tarda, acute intermittent porphyria, ALA-dehydratase deficiency porphyria, hepatoerythropoietic porphyria, variegate porphyria, hereditary coproporphyria, congenital erythropoietic porphyria, erythropoietic protoporphyria, and X-linked protoporphyria. These metabolic disorders can be classified as either erythropoietic or

hepatic porphyria. Additionally, these metabolic disorders can be classified as either cutaneous or acute based on the signs and symptoms. This article looks at the pathophysiology, clinical manifestations, diagnosis, treatments, and novel drug therapy options of porphyrias in hopes of increasing awareness of these diseases and dosage forms among healthcare professionals.

Nathan Anthony, OMS III (1) , Clayton Johnson, OMS III (1), Nathan Douthit, MD (1 & 2) (1) Edward Via College of Osteopathic Medicine-Auburn Campus; (2) East Alabama Medical Center – Opelika, AL Cl i n i ca l Case Repor t | Med i ca l St udent Actinomyces Acting Out: A. Europaeus as an Emerging Cause of Necrotizing Fasciitis 18

Actinomyces europaeus is a facultatively anaerobic, gram-positive filamentous rod that is a culprit of abscesses, decubitus ulcers, and UTIs. Until the year 2019, A. europaeus had never been known to cause necrotizing infections. To our knowledge this is the second case report of A. europaeus associated necrotizing fasciitis. A 60-year-old female patient with a history of type 2 diabetes mellitus and hypertension presented to the emergency department with encephalopathy. The patient developed a decubitus ulcer while hospitalized for COVID-19 infection 11-days prior. She was prescribed cephalexin and trimethoprim-sulfamethoxazole, but after discharge home she began dressing the ulcer with cornstarch. Now, the ulcer had progressed to a draining abscess with overlying crepitus and black eschars involving the left buttock, labia, medial thigh, and flank. The patient’s vital signs were as follows: BMI of 35.73, blood pressure of 70/34 mmHg, pulse rate of 108 bpm, respiratory rate of 22/min, temperature of 36.5 ºC, and oxygen saturation of 98% on room air. Her labs were significant for creatinine of 2.9 mg/dL, lactic acid of 10.5 mmol/L, glucose of 736 mg/dL, creatine phosphokinase of 340 IU/L, and WBC count of 12 x 103/ L. The patient was started on empiric antibiotic therapy with meropenem, clindamycin, and vancomycin. Surgery was performed; all skin, subcutaneous tissue, and fascia were removed extending from the left buttock to the left costal margin. On post-operative day five, deep tissue cultures showed a polymicrobial anaerobic infection with heavy growth of A. europaeus. The antibiotic spectrum was narrowed to piperacillin-tazobactam, but over the

subsequent days the patient developed severe respiratory distress. On hospital day 12, the patient developed multisystem organ failure and ultimately expired. Actinomyces are slow-growing organisms; incubation takes five days before growth appears but can occur as late as 15-20 days. While culturing for this type of infection is accessible, studies have shown that only 21% of hospitals have in-house antibiotic susceptibility testing available for anaerobic infections. Therefore, current literature recommends treating polymicrobial actinomycosis with beta-lactam antibiotics. Penicillin G is an exception, as the anaerobes accompanying Actinomyces often produce neutralizing beta-lactamases. Accepted regimens consist of piperacillin- tazobactam or carbapenems for systemic infections as these cover for gram-negative and beta-lactamase producing organisms. While this treatment plan is sufficient for most cases, it may not be ideal for A. europaeus, specifically. In fact, recent studies have found that A. europaeus is among the most resistant species of its genera as it exhibits resistance to erythromycin, ceftriaxone, ciprofloxacin, clindamycin, and piperacillin-tazobactam. The same studies also showed susceptibility to aminopenicillins, carbapenems, vancomycin, tigecycline, and doxycycline. Although Actinomyces has been a docile organism in the past, the emergence of resistance and evolution of A. europaeus to cause necrotizing fasciitis could alter our approach for treating these infections in the future.

15 2022 Via Research Recognit ion Day

S imu l a t i on Resea rch | VCOM Facu l t y A Virtual End-Of-Life Simulation: An Effective Methology for Learners

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Dr. Tiffani Chidume, RN, CCRN-K, CHSE, CHSOS Auburn University School of Nursing

There is a deficit in prelicensure learner knowledge regarding empathy and communication with families experiencing death and dying of a loved one. The purpose of this virtual telecommunication (VT) pilot simulation-based experience (SBE) was to address the gap of learner experiences communicating with the family of a dying loved one and produce feelings of empathy virtually, due to COVID-19. Often, the empathy component does not translate from the scenario to the learner(s), as they tend to concentrate more on completing patient care tasks than comforting the patient and family members. A virtual telecommunication simulation-based experience was written, designed, and piloted for prelicensure BSN students, due to the cancellation of face-to-face learning related to the Covid-19 pandemic. The Zoom platform was used to conduct the sessions. Standardized patients played a pivotal role in the SBE and helped draw feelings of empathy and sympathy from learners. The Zoom format was adequate to host the simulation-based experience that focused on the end-of-life. Producing feelings of empathy may be difficult in any setting, especially virtually. The well- written script and utilization of standardized patients enhanced the experience and was very realistic. Standardized patients were able to emotionally connect with their character from past experience

from the loss of a loved one. Students completed the experience individually and many revealed they had never provided a patient update to anyone, to the experience was appreciated. Almost ninety- three percent of the learners strongly agreed that they felt more confident communicating the patient status after the SBE. When comparing faculty and student feedback, the virtual SBE was more beneficial than the previous face-to-face one. The virtual telecommunication simulation-based experience was an effective modality for learners to gain experience talking to families of a dying patient. The practicality of the script and the SPs’ ability to transfer their emotions to learners were vital for the success of this SBE. The simulation was more beneficial than the previous face-to-ace modality because the students had to concentrate on having a difficult conversation that most had not yet experienced in the clinical setting. In the previous end-of-life simulation, learner objectives included caring for the patient as well as communicating with a family member. Learners disclosed they never considered having this conversation with family members and felt more confident giving patient updates after the SBE. Due to the achievement of this SBE and the modality, the course leader has requested the end-of-life simulation remain virtual, even after normal face-to-face university procedures resume.

Bradley A. Ruple 1 ; Morgan A. Smith 1 ; Shelby C. Osburn 1 ; Casey L. Sexton 1 ; Joshua S. Godwin 1 ; Michael D. Roberts 1,2 ; Kaelin C. Young 1,2 1 School of Kinesiology, Auburn University; 2 Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine – Auburn Campus Cl i n i ca l Resea rch | Gr adua te/Undergr adua te St udent Agreement Between Mri, Ultrasound, and Histology in Detecting Size Changes of the Vastus Lateralis Following Resistance Training 20

The size and change in size of the vastus lateralis (VL) muscle is commonly analyzed using a variety of imaging techniques including magnetic resonance imaging (MRI) and B-mode ultrasonography (US) with MRI being perceived as the gold standard for its ability to segment tissue compartments at a high resolution. The common method of assessing myofiber hypertrophy is by quantifying fiber cross-sectional area (fCSA). We tested whether these methods were accurate and reliable at detecting skeletal muscle hypertrophic changes following resistance training. Twelve healthy, untrained, college-aged males (20±1 y; BMI: 26.9±5.4 kg/m 2 ) had VL assessments via MRI, B-mode ultrasound (thickness and cross-sectional area) prior to (PRE) and after 10 weeks of resistance training (POST). Muscle biopsies were obtained at the site of imaging at PRE and POST for mean fCSA determination. Agreement between MRI mCSA (mCSA MRI ) and panoramic-based ultrasound mCSA (mCSA US ) at PRE and POST as well as change scores in these variables were examined using Bland-Altman plots for mean bias and 95% limits of agreement (LOA) as well as Lin’s concordance correlation coefficients (CCC). The relationship between fCSA with mCSA MRI , mCSA US , and B-mode ultrasound thickness (VL Thick ), as well as VL Thick and mCSA MRI were tested with Pearson’s correlations. Both mCSA MRI and VL Thick significantly increased following training

(28.1±6.1 to 31.1±6.9cm 2 (p=0.005) and 2.35±0.35 to 2.63±0.39cm (p=0.001), respectively). mCSA US and fCSA did not significantly increase with training (26.3±6.4 to 28.3±7.5cm 2 (p=0.064), and 4896±901.3 5443.2±1449.3µm 2 (p=0.12), respectively). Bland-Altman analysis revealed a small mean bias in mCSA US relative to MRI (-2.29 m 2 , 95% LOA: -8.74, 4.15 cm 2 ). Concordance between mCSA US and mCSA MRI taken at PRE and POST time points were excellent (CCC=0.83). Bland-Altman analysis revealed good agreement between change scores in mCSA US and mCSA MRI (-1.08cm 2 , 95% LOA: -5.49, 3.33 cm 2 ). There was a moderate concordance between mCSA US and mCSA MRI change scores (CCC=0.70). A positive, moderate correlation was found between percent change in both VL Thick and mCSA MRI as well as VL Thick and mCSA US (r=0.39, p=0.071 and r=0.52, p=0.080, respectively). A negative correlation was found between percent changes in fCSA and mCSA MRI (r= -0.569, p=0.054). Finally, correlations were not significant between percent changes in VL Thick and fCSA (r=0.053, p=0.871) or fCSA and mCSA US (r= -0.271, p=0.394). These data suggest that, relative to MRI, panoramic ultrasound is a reliable method to track mCSA changes of the VL. However, fCSA changes do not associate with tissue level changes, and this discordance warrants further research.

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