Auburn Research Day 2022

Cl i n i ca l Case Repor t | Med i ca l Res i dent /Pos t Doc Football and Flying Do Not Always Go Well Together

54

Stephen Despins, DO (1, 2); Mark Rogers, DO (1, 2); Brett Griesemer, LAT, ATC (1); Alex Black, MAEd, LAT, ATC (1) 1) Virginia Polytechnic Institute and State University; 2) Edward Via College of Osteopathic Medicine – Virginia Campus

History: A student athlete (SA) presented to the team sports medicine physician with anterior neck soreness after the football game. There was no inciting event that the SA could recall though later he did report that he remembered taking a hit from the right shoulder into his right chest. Although pain started after the football game, the SA noticed it got worse after the return flight home. The SA denied any respiratory distress, cough, or trouble swallowing. The following day, however, the SA noted voice changes. Physical Exam: Trachea was midline. There was tenderness over the muscle belly of both sternocleidomastoid (SCM) and at both attachment sites at the clavicle with no crepitus. He had pain with side bending and rotation of the neck in both directions. Lungs were clear to auscultation with no wheezes, rales, or rhonchi. Osteopathic Exam demonstrated T2-T6 N SrRl, Ribs 2-6 posterior on the right. Differential Diagnosis 1) SCM strain 2) Cervical myofascial pain 3) Thoracic somatic dysfunction 4) Rib somatic dysfunction 5) Pneumomediastinum 6) Subcutaneous emphysema Tests & Results: Xray: No pleural effusion. No pneumothorax is appreciable. There is soft tissue gas overlying the bilateral neck bases. CT Chest Findings: Extensive subcutaneous and deep soft tissue emphysema throughout the neck and bilateral supraclavicular regions most suggestive of pneumomediastinum.

Final/Working Diagnosis: Pneumomediastinum Treatment: The SA underwent a laryngoscopy with ENT, after the initial X-ray results demonstrated soft tissue gas. Then, a CT Chest with the above findings was obtained. The SA was then evaluated by Pulmonology. He was informed that he could not play in the upcoming game due to the results of the CT. Recommendations included to avoid heaving lifting and to avoid any activities that would increase his intrathoracic pressure. The pulmonologist also recommended not flying for 2 weeks following resolution. At his next follow-up with the sports medicine team physician, gentle articulatory techniques to the c-spine, t-spine, and ribs were performed which the SA tolerated well. Outcome & Follow-up: The SA did not play in the following game. 2 weeks later, repeat CT Chest showed near complete resolution of the pneumomediastinum. After discussion with Pulmonology, the SA was cleared to return to play. Return to Activity: For his first game back, the SA was transported by personal vehicle to the game rather than flying with the rest of the team because of the theoretical risk of spontaneous pneumothorax. He suffered a pulmonary contusion during the game after taking a hard hit but no pneumothorax. Besides some chest discomfort, the SA has been doing well ever since and competed in the rest of the season.

Suhrud Pathak 1 ; Sindhu Ramesh 1 ; Jack Deruiter 1 ; Muralikrishnan Dhanasekaran 1 ; Manoj Govindarajulu 1 ; Timothy Moore 1 Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University B i omed i ca l Resea rch | Gr adua te/Undergr adua te St udent Thuja Occidentalis in a Novel Phytosomal Formulation with Improved Stability and Pharmacokinetic Profile 55

The integumentary system is the human body's greatest vital organ, yet it also has a number of illnesses and disorders associated with it. Skin pathologies like, inflammation, infection, and cancer, impact individuals of all ages, sexes, and lifestyles all over the world, lowering the quality of life and shortening life expectancy. Sadly, billions of dollars and many hours of crucial patient time are spent on its prevention, treatment, and care. At present, different routes of dosage forms are available, such as oral, topical, or parenteral, which are used to diagnose and treat a range of skin conditions. New innovative skin formulations are now being studied due to decreasing bioavailability, side effects, and hypersensitivity-related issues. Due to the existence of beneficial bioactive, multipotent pharmacodynamics effects, and negligible contraindications, different natural products are currently widely used and in the growing market. Thuja occidentalis comprises volatile oils, tannins, coumarins, and flavonoids, which include antioxidant, anti-inflammatory, anti-carcinogenic, antibiotic, and trophic properties, making it a viable natural product for the prevention and treatment of a variety of human diseases.

Thuja occidentalis, on the other hand, have a number of issues with their oral routes. As a result, topical methods would be far more therapeutically useful, as they limit the likelihood of systemic side effects and medication interactions. Phytosomes are a novel and cutting-edge medicine delivery device for today's and tomorrow's worldwide health care. Throughout this study, innovative phytosomal formulations containing the Thuja occidentalis extract were developed, tested, and validated for stability (based on stability and storage, drug content and entrapment, morphological studies, Scanning Electron Microscopy, particle size, solubility, and spreadability studies), in vitro release (Quercetin), and in vivo skin hypersensitivity reactions. Thuja occidentalis phytosomal formulations were stable, possessed excellent bioavailability, and, most crucially, showed no in vivo allergic indications. Valid phytosomal preparations of Thuja occidentalis can thus be used as a cosmetic and medicinal dosage form for the prevention and treatment of a variety of skin illnesses and disorders.

32