Medical Student Submissions [L – M]

Emily Shi
eshi3@uic.edu

FIGO represents over 130 OBGYN National Societies across the globe. Members of the FIGO Well Women’s Committee represent 12 countries including India, Italy, United States, Germany, Mexico, Egypt, among others. Our work was prompted by a recent report from the UN Office of the High Commissioner on Human Rights, which called on governments to address preventable causes of harmful sexual and reproductive health outcomes experienced by women globally. Objectives were to produce a toolkit which can be leveraged in LMICs to expand preventative care services and recommendations for key entry points for FIGO society members to engage stakeholders and policymakers. We also aimed to facilitate policy development and provide a valuable, evidence-based supplement to the practice of a wide range of women’s healthcare providers. We conducted a thorough review of current evidence-based guidelines and reports from leading international organizations. We developed a toolkit to facilitate patient education which was launched at the FIGO World Congress in Paris, France, where it was shared with over 8,000 OBGYNs from across the globe. The lack of preventive services is a manifestation of the under-prioritization of women’s health at a policy level and, as such, is a denial of their human rights. By leveraging the wide visibility of FIGO, we aim to amplify the importance of preventative care for women and girls, empowering leaders to advocate for a human rights-focused lens in their countries.

Hunter Levingston
levings2@uic.edu
Peoria Campus

Purinergic P2 receptors, activated by extracellular ATP, are crucial in energy utilization and cellular signaling, making them key targets for stroke therapies. This study examines the temporal mRNA expression of all purinergic P2 receptors in rats and mice during the first week following ischemic stroke. Young male rats and mice underwent transient focal cerebral ischemia followed by reperfusion. Brains were harvested from different animal cohorts on post-ischemic days 1, 3, 5, and 7. Real-time PCR analysis was performed to examine the mRNA expression of various Purinergic P2 receptors. The receptors with upregulated expression in both species were P2X2, P2X3, P2X4, P2X7, P2Y2, and P2Y6. While these similarities were observed, notable differences in receptor expression emerged between rats and mice. Rats exhibited a broader receptor profile, with six additional purinergic receptors (P2X1, P2X6, P2Y1, P2Y12, P2Y13, and P2Y14) significantly upregulated compared to only one receptor (P2Y4) in mice, highlighting species-specific regulation of receptor expression distinct from the shared receptors. Following stroke, P2Y12 was the most upregulated receptor in rats, while P2Y2 was the most upregulated in mice. Finally, only one receptor was downregulated in rats (P2Y12) and in mice (P2Y14), with no receptors downregulated in both species. These findings reveal both conserved and species-specific changes in purinergic P2 receptor expression following ischemic stroke.

Anna Li
annali2@uic.edu
Chicago Campus

Background: THC is present in a wide variety of cannabis products. Access to more products is increasing. THC binds to cannabinoid receptors in the brain, causing effects such as changes in affect.

Methods: Healthy young adults who use cannabis (YA; n = 35) ages 18-25 were recruited using flyers as part of a larger study investigating how YA respond to THC in a double-blind, placebo-controlled, within-subjects, randomized design. Participants were either given placebo or 7.5 mg dronabinol at study visits. They answered surveys about their mood and the Drug Effects Questionnaire (DEQ) at baseline and at regular intervals throughout the drug administration visits. Analyses used t-tests and a Mann-Whitney U test.

Results: Four participants were excluded from analysis due to missing resting state MRI data. Of the participants included (n = 31), they reported that they felt mild to moderate drug effects (M = 35.548, SD = 29.821, t(30) = 6.637, p < .001) and felt high (M = 34.032, SD = 33.875, t(30) = 5.594, p < .001) during THC compared to placebo. However, participants did not feel a difference in positive affect (t(30) = -1.504, p = .143) or negative affect (V = 223, p = .420).

Conclusion: While participants did feel a difference in drug effects and intoxication levels during THC intoxication compared to placebo, there was no significant difference in positive or negative affect. These findings suggest that THC may not significantly alter positive or negative affect.

Davey Li
dli61@uic.edu
Chicago Campus

Hemodialysis (HD) patients are at high risk for CVD; approaches to reducing the risk of CVD include pharmacologic therapies and nonpharmacologic interventions, with exercise representing an important nonpharmacologic intervention. Recently, conventional exercise interventions have been supplemented with technological advancements like virtual reality (VR) and exergaming, providing engaging, multisensory rehabilitation options.

Results: Out of the 45 references, 14 studies consisting were applicable, 5 of which reported eligible outcomes (3 for exercise tolerance, 4 for gait speed, and 2 for depression). VR-based exercise and exergaming were associated with significantly increased exercise tolerance, with an average increase 78.3 m
[95% CI 31.6 to 125.0, I =31%] in distance on the 6-minute walk compared to the control group (Fig1). Likewise, walking speed was increased an average of 0.16 m/sec [95%CI 0.09-0.24, I =0%] among those in the intervention group (Fig2), and depression was decreased, with standardized mean difference (hedge’s g) of -0.49 [95% -0.84 to -0.19, I =0%] (Fig3).

Conclusion: VR-based exercise and exergaming increased exercise tolerance and gait speed, and decreased depression in the current meta-analysis.

Dvaey Li
dli61@uic.edu
Chicago Campus

Patients receiving hemodialysis (HD) experience various types of symptom burden. Anxiety, depression, and pain are common comorbidities for patients with CKD receiving HD. Randomized controlled trials have shown music to have positive health benefits among patients receiving HD.

Results:
Among the 83 citations identified by our search strategy, 19 studies met our eligibility criteria for inclusion, and 11 (total n =765) reported effect sizes and measures of variance for quantitative synthesis (7 for anxiety, 3 for depression, and 4 for pain). Music was associated with significantly decreased anxiety, with standardized mean difference (hedge’s g) of -0.65 [95% CI -1.10 to -0.20, I2=76%] compared to the control group (Figure 1). Depression, on the other hand, showed no statistically significant difference with a standardized mean difference of -0.56 [95% CI -1.27 to 0.15, I2=61%] for the intervention group compared to the control group (Figure 2). Pain was decreased in the intervention group compared to the control group, with standardized mean difference of -1.91 [95% -2.74 to -1.35, I2=11%] in visual analog scale (Figure 3).

Conclusion:
Music decreased anxiety and pain among the patients with HD in the current meta-analysis.

Stephanie Lopez
slope@uic.edu
Rockford Campus

Non-small cell lung cancer (NSCLC) makes up 85% of lung cancer cases and several patients experience resistance to EGFR tyrosine kinases (TKIs) due to mutations in EGFR. Resistance could arise from pathway alterations and/or epithelial-mesenchymal transition (EMT). Lysocardiolipin acyltransferase (LYCAT) is a mitochondrial enzyme involved in cardiolipin remodeling. LYCAT promotes NSCLC proliferation, migration, and EMT, but its role in TKI resistance remains unclear. We hypothesize that LYCAT overexpression drives EGFR-TKI resistance by upregulating EMT and NSCLC progression. LYCAT expression was evaluated in drug-resistant (ER/OR) and parental H358, H2170, and PC9 NSCLC cell lines using Western blotting, qRT-PCR, and immunofluorescence. IHC correlated LYCAT expression with NSCLC stages and smoking status. LYCAT protein expression was upregulated 3.8-fold in H358ER and 7.6-fold in PC9ER cells (p < 0.05). qPCR showed a 4.2-fold increase in these cells (p < 0.01). IF revealed increased nuclear/cytoplasmic LYCAT in H358ER (1.6-fold) and PC9ER (1.5-fold). Late-stage tumors showed higher LYCAT expression (75%) than early-stage (45%; p < 0.01), with smokers having elevated expression compared to non-smokers (68% vs. 34%; p < 0.001). In conclusion, LYCAT mediates EGFR-TKI resistance, NSCLC progression, and smoking-related lung cancer through increased EMT and tumorigenicity. Targeting LYCAT may offer therapeutic solutions for TKI resistance, improving patient prognosis.

Daniel Lopez
juandl2@uic.edu
Chicago Campus

Ocular diseases, including retinal vascular occlusion, diabetic retinopathy, and acute glaucoma, are often linked to retinal ischemia-reperfusion (IR) injury. Previous studies have demonstrated that extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) possess neuroprotective properties, making them a potential alternative to MSCs. Among MSC sources, dental pulp stem cells (DPSCs) are notable for their neurogenic origins, and DPSC-derived EVs have been shown to restore inner retinal cell function following ischemic insult. This study investigated whether artificial EVs (A-EVs) engineered to express miR-22-3p, a miRNA associated with anti-apoptotic and anti-inflammatory pathways, could replicate the neuroprotective effects of DPSC-derived EVs.

Despite their theoretical potential, A-EVs expressing miR-22-3p did not significantly improve B-wave recovery in ischemic retinas compared to the control group (PBS). However, A-EVs partially preserved the N95 component of the pattern electroretinogram (PERG), while the P50 component remained unaffected. Although trends in the data suggest miR-22-3p may confer neuroprotection to specific retinal components, the findings were not statistically significant, possibly due to the small sample size (n=5-6). Overall, this study highlights the need for further research to elucidate the role of miR-22-3p in retinal neuroprotection and to optimize therapeutic strategies using EVs.

Caitlin Lu
clu45@uic.edu
Chicago Campus

Women with sickle cell disease (SCD) are believed to experience progressive iron overload with age, particularly post-menopause, due to increased lifetime blood transfusions and end of menstruation. However, longitudinal studies examining iron status in women with SCD are limited. This single-institution study evaluated iron trends with aging in adult women with SCD seen at the UI Sickle Cell Center from January 2021 to November 2024.

Exclusion criteria included a history of stem cell transplant or pregnancy. 105 patients (≥18 years) were identified. Data collected included age, last menstrual period, ferritin, transferrin saturation (TSAT), and SCD genotype: SS, SC, S+, or S0. Patients were grouped by age: post-menopausal 50+ (n=46), perimenopausal 31-49 (n=41), and pre-menopausal 18-30 (n=25). Median ferritin increased with age: 592.8 in the 50+ group, 218 in the 31-49 group, and 176 in the 18-30 group. TSAT showed a modest decrease: 29.2, 32, and 34.3, respectively. Moderate positive Spearman correlations were found between genotype severity and ferritin (r=0.50) and TSAT (r=0.59).

This study highlights a significant rise in ferritin with age in women with SCD, particularly post-menopause, while TSAT declines. SS patients had the highest ferritin and TSAT levels, likely due to greater hemolysis and iron overload. These findings emphasize the importance of iron status monitoring and management in aging women with SCD. Future studies will explore age-matched male cohorts.

Anjani Maley
amaley3@uic.edu
Peoria Campus

Background:
Time to antibiotic administration (TTA) is an important quality of care indicator for hospitals caring for oncology patients who present with febrile neutropenia (FN). It is recommended that all patients with neutropenia presenting with a fever should receive empiric, broad-spectrum antibiotics within 60 minutes of presentation. OSF Children’s Hospital of Illinois has a unique protocol to achieve rapid TTA that has not been described before.

Objectives:
To evaluate OSF’s current process of febrile neutropenia management in pediatric oncology patients by assessing TTA in patients with febrile neutropenia.

Methods:
We utilized a retrospective cohort single institution study over 5 years. It includes pediatric
oncology patients between the ages 0-30 years old undergoing chemotherapy with central venous or peripherally inserted central line. Patient charts were reviewed and information such as TTA, length of stay, escalation of care as well as outcome (discharge vs. mortality) were collected.

Results:
We reviewed 328 unique patient encounters from January 1, 2018 to December 31, 2022 presenting with fever neutropenia. The average time to antibiotics recorded was 19.5 minute. If admitted to the hospital, the average length of stay (LOS) was 3.09 days. Only 6/328 (0.018%) of the patients were escalated to pediatric ICU (PICU), with with no patient mortality during the admission or outpatient encounter for fever neutropenia.

Roosha Mandal
rmanda7@uic.edu
Chicago Campus

Chronic lower back pain (cLBP) is a leading musculoskeletal problem with limited understanding of the contributions of genetics. Investigating epigenomics, such as DNA methylation, can help to better characterize cLBP in the context of clinical measures. The objective of this study was to identify differentially methylated regions (DMRs) in the context of low, medium, and high levels of disability as measured by the Oswestry Disability Index (ODI) in chronic low back pain.

Whole blood was collected from 96 cLBP patients along with ODI data. DNA was extracted and bisulfite converted prior to sequencing. Ten samples were discarded due to low bisulfite-converted DNA integrity. ODI was calculated based on a 10 factor scale, with a maximum possible score of 100, with categorization of Low: 0-20 (n=19), Medium:21-40 (n=43), and High:41< (n=23).

No difference was found in DNA methylation between the Low and Medium ODI groups and the Low and High groups. In the Medium and High ODI group comparison, 73,711 probes were found to be differentially methylated, with 50,997 probes with increased methylation in the Medium-ODI group compared to the High-ODI group. The 5 most significant genes in these regions were: BRD2, previously associated epilepsy; RNF5, which codes for ubiquitin ligase; SCAND3, a predicted oncogene; MDC1, associated with DNA damage repair; and AGPAT1, which falls in MHC class III gene.

Dan Marian
dmari6@uic.edu
Chicago Campus

Caspase-12, an endoplasmic reticulum (ER) stress marker, is known to be an ER-stress induced apoptosis initiator (a key process in cardiomyocyte remodeling). As such, we hypothesized that caspase-12 deficiency may protect against heart failure. To investigate this hypothesis, we employed a genetic and pharmaceutical murine model. In the genetic model, caspase-12 knockout (KO) mice and their wild-type siblings (WT) underwent ligation of the left anterior descending coronary artery (LAD) to induce myocardial infarction (MI). Heart function was assessed at Day 1 and Day 3 via echocardiography. M-mode analysis of short-axis views and B-mode global longitudinal strain analysis revealed significantly higher systolic function in caspase-12 KO compared to WT mice at D1 and D3, despite no pre-MI differences. Additionally, TTC staining was used to calculate the area of infarct for the KO and WT groups, resulting in a significantly larger area of infarct in WT mice. For the pharmaceutical model, WT mice were divided into two groups: the inhibitor group received caspase-12 inhibitor treatment (Z-ATAD-FMK in DMSO), and the vehicle group received DMSO to account for potential toxicity. Both groups underwent LAD ligation, and heart function was monitored at D1 and D3, indicating significantly improved LV systolic function in the inhibitor-treated mice. Given the cardioprotective effects of caspase-12 deficiency, inhibition of the ER stress apoptotic pathway emerges as a therapeutic target.

Alfredo Martinez Ruiz
amart251@uic.edu
Chicago Campus

Obstructive sleep apnea (OSA) is a common sleep disorder classified by repetitive interruption of breathing during sleep. Patients with craniofacial syndromes have abnormal facial structures putting them at higher risk of OSA, which can lead to increased risk of cardiovascular issues, learning difficulties, and poor growth and development.

We conducted a comprehensive literature search in the databases of PubMed and Embase using a combination of keywords and MeSH terms in English. Studies published within 30 years of January 1, 2024, which reported the potential of a clinical prediction model for OSA diagnosis in syndromic patients were included.

We identified 68 studies that met our inclusion criteria and are ready for data extraction including points like patterns in cephalometric features, severity of OSA symptoms, and polysomnography outcomes and OSA treatment outcomes. From these studies, a quick analysis revealed that a better approach includes breaking up studies based on diagnostic, prevalence, and intervention groups. No formal results can be extracted with the current point in the project.
Included studies thus far confirm that apnea symptoms are present in almost every patient with a craniofacial syndrome, yet treatments seem to vary. Development of a causal relationship is in the works and requires analysis of the data extraction portion with meta-analysis, and bias assessment.

Donald Mascio
dmasci2@uic.edu
Chicago Campus

Introduction: Flexor tenosynovitis (FTS) is typically a surgical emergency caused by bacterial infections, but atypical causes (aFTS) and variable Kanavel signs complicate diagnosis and treatment.

Methods: A systematic review of case reports (1999-2024) on atypical digital flexor tenosynovitis was conducted using PubMed, PMC, Scopus, and Cochrane. 1688 publications were screened, with 340 included for analysis. Data on demographics, risk factors, symptoms, diagnostics, and treatments were extracted. Cases were categorized as acute (0-2 weeks), subacute (3-8 weeks), or chronic (>8 weeks).

Results: 100 cases were analyzed. Kanavel signs were present in 87%, with fusiform swelling most common. Acute cases had an average of 2.7 signs, compared to 1.7 in subacute and chronic cases. 55 cases had an inciting event, and 36 were diagnosed clinically or with basic imaging. Advanced imaging (ultrasound, MRI) was used in 39% and 30% of cases. 47 cases had atypical infections (mycobacterial, fungal, viral), and 29 were autoimmune. Surgery was performed in 74% of acute, 77% of subacute, and 83% of chronic cases.

Discussion: FTS can have atypical causes, requiring further workup or treatments. Ultrasound and MRI should be considered, especially in subacute or chronic cases. Surgery remains the gold standard, though conservative treatments may suffice for some.

Clinical Relevance: Providers should recognize atypical FTS presentations to guide diagnosis and treatment.

Daniel McBride
dmcbri4@uic.edu
Peoria Campus

INTRODUCTION: Thumb opposition is essential for daily tasks, but carpometacarpal (CMC) osteoarthritis (OA) causes pain and reduced range of motion (ROM), severely impacting function. Radiographic evaluations of CMC OA focus on joint space narrowing, sclerosis, and osteophytes, but their correlation with functional limitations is unclear. This study examines whether radiographic severity reflects ROM limitations in thumb joints.

METHODS: Sixty-one patients with CMC OA were evaluated. Radiographic severity was graded from 1 (mild) to 5 (severe). ROM was measured for flexion, extension, abduction, adduction, and opposition at the CMC joint, and for flexion and extension at the MCP and IP joints. Pearson correlation coefficients and one-way ANOVAs analyzed relationships between radiographic findings and ROM.

RESULTS: Radiographic severity correlated significantly with CMC extension (p = 0.001) but not with CMC flexion (p = 0.895), abduction (p = 0.993), or ROM at MCP and IP joints. CMC abduction negatively correlated with MCP extension (r = -0.605, p < 0.001), reflecting compensatory changes in advanced OA.

DISCUSSION: Radiographic severity does not fully capture functional impairments in CMC OA. The negative correlation between CMC abduction and MCP hyperextension highlights biomechanical adaptations, emphasizing the need for comprehensive clinical assessments.

SIGNIFICANCE: Combining functional and radiographic evaluations may improve CMC OA diagnosis and management.

Caitlin McBride
cmcbri4@uic.edu
Chicago Campus

Jalapa, Guatemala, a city with a population of 120,715, is part of a larger department with an estimated population of 350,000 to 400,000. The region faces significant challenges, with 69.9% of its residents living in poverty and 18.4% in extreme poverty. Its healthcare system is divided among public, private, and social security sectors, and its distance from Guatemala City (96 to 168 km, depending on the route) complicates healthcare access. Having gone to Jalapa to implement Global Medicine (GMED) scholarly concentration projects, we now seek to share the key barriers identified through a comprehensive needs assessment, discussions with healthcare workers, and direct observations.

Daniel McBride
dmcbri4@uic.edu
Peoria Campus

Background: Surgeries on the kidney, bladder, and prostate represent a significant proportion of the practice in urologic surgery and confer substantial risk of morbidity and mortality. Currently, few models exist for calculating risk for these specific procedures. We hypothesize that the Model for End-stage Liver Disease (MELD) 3.0 score is an objective tool that can predict mortality in these patients.

Methods: Using the NSQIP database we obtained data on patients undergoing partial and total nephrectomies, cystectomies, and prostatectomies. Using logistic regression, an odds ratio table comparing patients at each MELD score to patients of all other MELD scores was created to model possible risk reduction if a patient were to be optimized to a lower MELD score. Separately, using the observed mortality rate at each MELD score, a line of best fit was calculated to provide a predictive equation for mortality at each MELD value.

Results: A total of 58,616 patients had sufficient data to calculate a MELD score and were included in the study. The predictive line of best fit showed a baseline expected mortality of 0.29% at a MELD of 6 increasing to 1.92% at a MELD of 15. The comparative odds ratio table showed that a reduction in MELD from 9 to 7 conferred a 49.1% reduction in odds of mortality.

Discussion: MELD shows promise as an adjunct for surgical risk assessment and optimization in urological surgeries.

Kelly McConnell
kmccon4@uic.edu
Chicago Campus

A common challenge faced during laparoscopic surgery is the removal of hollow organs from the abdominal cavity through small openings (less than one to two centimeters) in the abdominal wall during gastric sleeve surgeries, cholecystectomies, colectomies, appendectomies, and small bowel resections. The existing solutions generally consist of a polymer bag with purse string ties around the opening. When using these devices, surgeons often face difficulty removing the sample, especially as the sample increases in size, as the tissue will form a ball in the collection bag preventing removal through the fascia, or the bag will tear. This increases frustration in the surgical team, the duration of anesthesia, and may necessitate a longer incision. Furthermore, the available tissue retractors and surgical tools that are commonly used to aid in specimen retrieval are difficult to fit into the small incision, must be operated by multiple people, and impede visualization. Our goal is to design a solution to facilitate hollow organ removal during abdominal laparoscopic surgery that minimizes the incision size in the fascia.

Kelly McConnell
Kmccon4@uic.edu
Chicago Campus

Sickle cell disease (SCD) is an inherited disease caused by a point mutation in the beta-globin gene on chromosome 11 that affects the structure and function of hemoglobin. The abnormal globin leads to erythrocyte deformation when deoxygenated, causing pain, red blood cell lysis, and inflammation which can result in chronic pain, damage to the spleen, anemia, and stroke. This pilot study investigates the use of heart rate variability (HRV) in pediatric patients with and without SCD as a measurement of autonomic nervous system (ANS) function and pain. HRV is the variation in the time between heart beats. HRV is assessed in patients in the primary care setting as a baseline, in patients hospitalized for SCD vaso-occlusive crises (VOC), and in patients on chronic transfusion for SCD. The effects on HRV of complementary medicine treatment for pain, such as listening to music, will also be evaluated. The primary hypothesis is that HRV will decrease with increased pain levels. HRV will increase after transfusion, with treatment of VOC pain, and with use of complementary medicine techniques. Additionally, patients with SCD are hypothesized to have lower HRV than patients without SCD due to ANS dysregulation.

Sara McMaster
smcma@uic.edu
Rockford Campus

To understand the cellular dysfunction involved in the pathogenesis of neurodegenerative features of SPG11 linked disorders, motor deficits and neuronal cell loss were analyzed in heterozygous, homozygous and wild-type (WT) mice.

Endurance parameters indicated motor deficits in homozygous mice, reflected by reduced riding time and maximum speed. Tbr1 staining, used to quantify density of motor neurons in the deep cortex showed lower densities in homozygous compared to Heterozygous. This is consistent with the recessive feature of SPG11 patients in which both alleles of the SPG11 gene are mutated, leading to the loss of spatacsin protein function. The WT mouse experienced significant phenotypic complications probably related to another disease process. Future studies on more mice need to performed for comparative analysis.

NF200, a stain used to analyze neurofilament and neuronal function showed reduction of intensity in the homozygous genotype indicating a potential correlation with complete loss of the spatacsin to loss of motor neurons and further behavioral motor deficits. While our study found phenotypic and molecular differences between genotypes linking the spatacsin gene to neurodegeneration of the deep cortex and suggesting its impact on motor functioning, in the future we hope to analyze more animals and to co-localize filipin staining to different cellular compartments to further elucidate spatacsin’s role in lipid functioning within the neurodegenerative process.

Eric Medenblik
emeden2@uic.edu
Peoria Campus

Background: Nutritional status is a known predictor of outcomes following surgery but, the optimal assessment tool is unclear. Highly accurate methods are cumbersome, difficult to use, and may subject the patient to unnecessary radiation. The Geriatric Nutritional Risk Index (GNRI), is an easy-to-use tool that has shown promise for predicting mortality after surgery. However, GNRI has not been previously validated to predict mortality and other outcomes in common orthopedic surgeries.

Methods: Using NSQIP data for 2021 and 2022, patients undergoing total and hemi-knee and hip arthroplasty were identified. Demographics and clinical characteristics were collected. The primary outcome was mortality. Secondary outcomes included MI, CVA, post-operative transfusion, DVT, PE, acute renal failure, unplanned reintubation, need for ventilator > 48 hours, and infections. Predictive value of GNRI was evaluated via AUROC, Brier score, and Hosmer-Lemeshow tests.

Results: Among 75,472 patients, GNRI showed high utility in predicting mortality (AUC=0.839; Brier Score=0.0067). GNRI was also useful for predicting cardiac arrest (AUC=0.721; Brier Score=0.0019), prolonged ventilation (AUC=0.703; Brier Score=0.0010), transfusions (AUC=0.733; Brier Score=0.0244), and pneumonia (AUC=0.731; Brier Score=0.007). GNRI did not show strong utility for predicting infectious or thrombotic complications.
Conclusions: GNRI is a useful adjunct for prediction of mortality and some postoperative morbidities.

Eric Medenblik
emeden2@uic.edu
Peoria Campus

Background: Below-knee amputation (BKA) often results from vascular disease due to comorbidities like diabetes, hypertension, and heart failure. These conditions contribute to chronic wounds that may progress to sepsis, necessitating urgent or emergent intervention. Preoperative optimization is critical for improving outcomes, but delays in surgery may also have negative impacts. We hypothesize that moderate delays for optimization may benefit patients but that delays beyond a certain threshold may increase risk.

Methods: Using NSQIP data from 2017-2019 and 2021-2022, we identified patients undergoing BKA. Demographics, case type (emergent, urgent, or elective), and comorbidities were analyzed. The primary outcome was mortality with secondary outcomes including infectious and thrombotic complications, need for transfusions, and return to OR. Chi-square regression evaluated time to surgery after admission groups: 0“24 hours (reference), 24“48 hours, 3“5 days, and >5 days, adjusted for key comorbidities.

Results: Among 13,868 patients, compared to surgery within 24 hours, only delays greater than 5 days showed significant increase in mortality (OR 1.295, p=0.018). Transfusion odds were increased when delayed beyond 24 hours, while septic shock odds decreased if delayed beyond 24 hours.
Conclusions: BKA may safely be deferred up to 5 days without increased mortality odds and with reduced odds of septic shock. This must be weighed against an increased need for transfusion.

Eric Medenblik
emeden2@uic.edu
Peoria Campus

Background: Predicting acute renal failure (ARF) in surgical patients often relies on traditional renal markers. However, the Model for End-Stage Liver Disease (MELD), originally developed for liver dysfunction, may challenge these metrics by incorporating systemic parameters. This study aims to validate MELD as a tool for predicting ARF in a surgical population, expanding its application beyond cirrhotic patients.

Methods: Using NSQIP data (2017“2019, 2021“2022), we analyzed 1,039,652 surgical patients, excluding dialysis-dependent cases and those for whom MELD could not be calculated. MELD 3.0, BUN, creatinine, BUN:Cr ratio, and eGFR equations [Cockcroft-Gault (CG), Chronic Kidney Disease-Epidemiology (CKD-EPI), Modification of Diet in Renal Disease II (MDRD II)] were assessed using AUROC, Hosmer-Lemeshow (H&L), and Brier scores. Analyses controlled for age, race, and case type.

Results: MELD demonstrated the highest AUC (0.840), outperforming creatinine (0.798), CKD-EPI (0.794), MDRD II (0.784), BUN (0.778), CG (0.758), and BUN:Cr (0.514). It also showed superior calibration (H&L) and the highest predictive accuracy (Brier score”0.0051).

Conclusions: MELD is the most reliable predictor of ARF in surgical patients, surpassing traditional markers in sensitivity, specificity, and accuracy. This is attributable to its integration of systemic parameters which capture the interplay between multiple organ systems. Preoperative risk stratification for ARF is now possible with MELD

Barbara Mera
bmera2@uic.edu
Peoria Campus

As robotic-assisted surgery (RAS) becomes increasingly common in medical practice, it remains underrepresented in medical school curricula, leaving prospective physicians to rely on informal sources like the internet and media, which lack quality control. Some surgical departments offer extracurricular courses on RAS, but the extent and approach to such training vary. This study evaluates medical students’ knowledge of RAS, awareness of training opportunities, and attitudes towards the technology.

A survey was conducted with 63 full-time medical students from a North American medical school, assessing their baseline knowledge, attitudes toward RAS, and demographic information, including class level and interest in surgery.

Participants, aged 20 to 39, included 80% preclinical students (years 1 and 2) and 19.1% clinical students (years 3 and 4). About 55.8% reported having some background knowledge of RAS. Most students had a positive view of RAS, with 58.7% believing it has expanded minimally invasive surgery and 81% supporting its adoption. On patient acceptance, 55.6% agreed patients would undergo robotic procedures, and 65.1% believed RAS would improve outcomes. However, 63.5% were unaware of their school’s RAS training opportunities, and 55.6% supported integrating RAS training into the curriculum.

While students show strong support for RAS, many are unaware of existing training opportunities. Most advocate for including RAS training in medical curricula.

Hind Mothana
hmotha2@uic.edu
Rockford Campus

This study examines the impact of volunteering on medical students’ sense of belonging within the Rockford community. A survey was conducted at the University of Illinois College of Medicine Rockford campus, exploring community involvement and a sense of belonging for medical students. The Sense of Belonging Questionnaire was adapted for this study and distributed via Qualtrics in June 2024.

Results indicate that 83% (n=46) of participants engaged in volunteer activities, with 66% (n=38) reporting a stronger connection to the community than 50% (n=8) of non-volunteers. Students with frequent and sustained volunteer engagements expressed deeper bonds and greater integration within the community.

This study highlights volunteering as a critical source of community for medical students despite limitations like small sample size and demographic skew toward M2 students. The study’s findings align with existing literature, emphasizing the importance of consistent, meaningful community engagement in fostering emotional ties and social integration.

Abdullah Mubarik
amubar2@uic.edu
Peoria Campus

Background: The Adult Nutritional, non-Geriatric Risk Index (ANGRI) assesses mortality risk in patients aged 18-64 using hemoglobin A1c, hematocrit, serum albumin, and actual-to-expected weight ratio. Appendectomy, a common low-risk procedure, may pose greater risk to nutritionally fragile patients who could benefit from non-surgical management. We hypothesized ANGRI could identify high-risk patients.

Methods: Using 2021-22 NSQIP data, we analyzed appendectomy cases, excluding those with missing ANGRI variables or outside the age range. Outcomes included mortality, complications (cardiac, respiratory, infectious, thrombotic), and transfusion need. Predictive performance was assessed using the c-statistic, Brier score, Hosmer-Lemeshow test, and Chi-square Automated Interaction Detection (CHAID).

Results: Among 5,391 patients, ANGRI’s c-statistic for mortality was 0.889 (95% CI 0.775-1, p <.0001), indicating excellent predictive ability. The Brier score of 0.0012 reflected high accuracy. For transfusion need, the c-statistic was 0.894 (95% CI 0.823-0.966, p <.0001) with a Brier score of 0.0058. Other outcomes were not strongly predictive. CHAID identified an ANGRI threshold of 203, below which mortality risk increased significantly.

Conclusions: ANGRI predicts mortality effectively in appendectomy patients. For scores below 203, non-operative management should be strongly considered to reduce mortality risk.

Abdullah Mubarik
amubar2@uic.edu
Peoria Campus

Background: Model for End-stage Liver Disease (MELD) Score accounts for metabolic derangements common in various disease processes and has been validated for predicting mortality beyond liver disease. Since these derangements may be modifiable, analyzing risk reduction by optimizing MELD scores offers potential benefits. MELD’s predictive value for mortality in cardiac and thoracic surgeries and the impact of optimizing MELD scores remain unexplored.

Methods: Our study analyzed NSQIP data from 2017-2022 (excluding 2020) for patients undergoing coronary revascularization, valve replacement, and pulmonary surgeries. Demographic data was reviewed, and MELD scores calculated using the MELD 3.0 formula. The primary outcome was 30-day mortality. Logistic regression compared mortality odds at each MELD score relative to all others.

Results: The dataset included 16,934 patients with valid variables. Compared to a baseline MELD of 6, mortality odds increased with higher MELD scores, ranging from 1.67 (MELD 7) to 28.74 (MELD 24). Beyond MELD 24, data was insufficient for analysis. Risk reduction analysis revealed significant mortality benefits within the powered MELD range: reducing MELD from 9 to 7 decreased mortality odds by 36.7%, MELD 13 to 10 by 56.0%, and MELD 15 to 14 by 59.5%!

Conclusions: In this large retrospective cohort MELD effectively predicts mortality for cardiothoracic surgeries up to MELD of 24 and estimates perioperative mortality benefits of optimizing MELD scores.