University of Miami Miller School of Medicine Volume 10 Spring 2022
Dean’s Letter
This year we proudly celebrate the 10th anniversary of the of The Medical I.B.I.S., the University of Miami Miller School of Medicine’s student-produced research publication. This special edition highlights the superb work of our talented student researchers who continue to fuel our optimism for the exceedingly bright future of the medical profession. The Miller School is committed to training the next generation of transformative leaders who will not only shape the future of medicine and lead health systems to deliver value-based health care but also champion discovery and its translation into clinical interventions to improve the health of humanity. To better prepare the next generation of physician scientists to extend the boundaries of discovery, last year, we launched the Office of Physician Scientist Traning to oversee and coordinate the training and development for our promising physician- and clinician-scientists. Our goal is to increase the number and diversity of physician-scientists and ensure their success along the lengthy path of academic medicine. We established the Dean’s Research Excellence Award in Medicine (DREAM) to enable interested students to spend one year doing hypothesis-driven, mechanism-oriented research under the mentorship of some of our talented principal investigators at the Miller School. There are seven students in the inaugural cohort of the DREAM program. Based on its rousing success, we plan to select up to 20 DREAM scholars for the next cohort. In addition, this summer we will offer competitive stipends to up to 50 medical students interested in pursuing research with an approved mentor during their 8-week summer break. We believe these programs will help Miller School students cultivate their interest in discovery and lead to many timely and important contributions to the scientific literature through publications in The Medical I.B.I.S. as well as other medical journals. In the meantime, I invite you to enjoy the 10th anniversary edition of The Medical I.B.I.S.
Henri Ford, MD, MHA Dean and Chief Academic Officer, UMMSM
President’s Letter
There is much talk about a new normal. I believe we have a once-in-a-century opportunity to build a better normal. We owe it to those who have suffered as a result of the pandemic to apply the lessons we are learning. One of those lessons is the vital role health care professionals play in the fabric of our society. Those on the front lines have emerged as role models and connectors, exemplifying the spirit of service that is a key aspect of our mission. The University of Miami Leonard M. Miller School of Medicine has successfully developed protocols and implemented new ways to teach, serve patients, and conduct research in an environment where Covid-19 remains prevalent. As we continue to navigate this unique circumstance, the University is focused on ensuring the health and safety of our students, as well as supporting their wellbeing. As president of this university and a physician, I fully understand the challenges brought about by the pandemic. I am certain that there are multiple opportunities for medical students to make meaningful contributions to research and care. The University encourages students to utilize varying ways to safely study, work, and socialize. The adaptability and determination of students impresses me daily, and I look forward to witnessing their success in the next phase of their academic careers.
Julio Frenk, MD, MPH, PhD President, University of Miami
The Medical IBIS | 21
A Letter from the Editors
Dear Readers, We are delighted to present the tenth volume of The Medical I.B.I.S. magazine to you! Since 2013, The Medical I.B.I.S. has showcased innovative research performed by medical students at the University of Miami Miller School of Medicine. All of our articles are written and edited by the medical students on our staff. In this issue, you will have the privilege of peering into a unique array of projects Miller students are engaged in, including the impact of influenza vaccination on surgical outcomes in COVID-19 patients, identification of a novel retroviral element in glioblastoma, and the future outlook of telemedicine adoption in surgical subspecialties. If we have learned anything from the past two years of this global pandemic, it is that we must address the concerns of today as well as tomorrow. A novel pathogen, challenge, or opportunity may be right around the corner, and our students’ incredible pursuits to further the field of medicine are a tribute to this mission and a signal of the bright future that lies ahead. We would like to thank the entire staff of The Medical I.B.I.S. for their dedication and commitment to crafting our tenth issue. We look forward to the impact this will have on the University of Miami community and beyond. Sincerely,
John Zizzo & Sherry Luo Editors-in-Chief, The Medical I.B.I.S.
The Medical IBIS | 21
Masthead Editors-in-Chief Sherry Luo John Zizzo
Managing Editors
Sherry Luo
John Zizzo
Jason Greenfield
Poorva Jain
Akshara Sree Challa
Rhiya Mittal
Sharon Hsieh
Shreya Ingle
Amirah Rashed
Amy Thein
Jamie Burgess
Ryan Guillen
Roshni Lalwani
Maya Lubarsky
Esdras Lopez
Matt Drewes
Michael Durante
Jeffrey Lowell
Jason Greenfield Poorva Jain
Senior Editors
Akshara Sree Challa Rhiya Mittal
Writers
Sharon Hsieh Shreya Ingle Amirah Rashed Amy Thein
Editors
Jamie Burgess Ryan Guillen Roshni Lalwani Maya Lubarsky Amirah Rashed
Photographer Esdras Lopez
Selection Committee Matt Drewes Michael Durante Jeffrey Lowell
Special thanks to Kelly Luo for contributing to and helping with layout design.
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Table of Contents
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Opioid Use & Missing Treatments by Alina Syros and Gabriela Rodriguez
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A New Approach to Treating TBI and PTSD in Rats
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Logic Model for CulturallyInformed Public Health Interventions with the HaitianAmerican Community in Miami feat. Irene Goo and Lounah Pierre-Gilles by Sharon Hsieh
feat. Haley Hullfish by Shreya Ingle
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How COVID-19 Changed Otolaryngology
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Redefining the Gold Standard: Pre-Operative MRIs for Early Stage Breast Cancer feat. Peter Borowsky by Amirah Rashed
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by Jake Langlie
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Cutting Through the Kidney Supply - Demand Mismatch
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Extraskeletal Myxoid Chrondrosarcoma - Clinical Features and Overall Survival feat. Jeffrey Brown by Sharon Hsieh
feat. Marinah Tabbara by Amirah Rashed
18
Protective Effects of the Flu Vaccine Against SARS-CoV-2
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A Murine Model of RadiationInduced Skin Fibrosis Suggests Response to Injury Extends Beyond the Treatment Field feat. Nathan Balukoff by Amy Thein
feat. Susan Taghioff by Amy Thein
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HML-6 as a Potential Novel Driver of Glioblastoma Formation feat.Vaidya Govindarajan by Shreya Ingle
The Medical IBIS | 6
Opioid Use & Missing Treatments by Alina Syros and Gabriela Rodriguez
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lina Syros and Gabriela Rodriguez are passionate about helping those with opioid use disorder (OUD). Their interest started during their time as staff members at the IDEA Clinic, which provides wound care to participants enrolled in the needle exchange program. Alina and Gabriela wanted to further understand the obstacles that patients with opioid use disorder face when seeking medical treatment. Mentored by Dr. David Serota, M.D., co-founder of the IDEA Clinic, Alina and Gabriela performed a telephone audit of Miami-Dade, Broward, and Palm Beach County pharmacies to see which ones carried buprenorphine-naloxone, a medication used to treat OUD. The project’s major finding was that most outpatient pharmacies do not carry buprenorphinenaloxone or any of its other formulations. Additionally, many of the outpatient pharmacies in the tri-county area were unwilling to order it. This severely affects patients’ ability to continue treatment outside of the inpatient setting and succeed in recovery, leaving people with OUD at an inherent disadvantage. Alina and Gabriela presented their project at APSA and in the spring will present at the conference of the American Society of Addiction Medicine. Going forward, Alina and Gabriela would like to compile a list of acute care hospitals and contact their inpatient pharmacies to assess their access to and prescription of buprenorphine-naloxone. After analysis of both inpatient and outpatient pharmacies, they hope to publish the project, spread awareness about the barriers facing those with OUD, and elucidate discrepancies between inpatient and outpatient facilities.
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Through our involvement with the IDEA clinic during our time as staff, we became passionate about helping those with opioid use disorder (OUD) and demonstrating the barriers that exist for many patients with OUD when attempting to obtain adequate treatment.
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Alina Syros (right) MD Class of 2024
Gabriela Rodriguez (left) MD/MPH Class of 2024
Honors: presentation at APSA 2021, upcoming presentation at conference for the American Society of Addiction Medicine Mentors: Dr. David Serota, MD, co-founder of the IDEA Clinic, and Dr. Hansel E. Tookes, MD, MPH, Director at IDEA Other Interests: Alina: cooking Maria: reading novels Future Goals: applying for residency
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This project has exemplified the importance of interdisciplinary management in order to provide the best patient care, something that will be important to consider when seeing patients in our career as physicians. Our hope is to continue to advocate for this population regardless of what specialty we go into.
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The project has helped Alina and Gabriela realize the importance of interdisciplinary management between physicians and pharmacists, which they will remember when seeing patients in the future. Alina and Gabriela hope to continue advocating for vulnerable populations and ensuring people with OUD are treated appropriately. When asked if they had any advice they wanted to share, Alina and Gabriela stressed the importance of balancing research and activities outside of research. In research, they believe that a team that shares the same passion, while also being fun to work with, helps greatly. Outside of research, they believe in finding time for things that make them happy – in their case, sports, yoga, or walking Brickell Key with friends. To successfully manage this balance, Alina and Gabriela set attainable goals, stayed organized, and ensured constant communication between team members. Alina and Gabriela want to thank their mentors and role models Dr. Serota and Dr. Hansel E. Tookes, M.D., M.P.H, Director at IDEA, and they welcome students to volunteer at the IDEA Clinic any Thursday.
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A New Approach to Treating TBI and PTSD in Rats by Shreya Ingle
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fter shadowing an otolaryngologist (or ear, nose, and throat (ENT)) physician in college and learning about the wide variety of diseases that otolaryngologists treat, Haley Hullfish, class of 2023, fell in love with the specialty. Otolaryngologists see a diverse population; patients can include war veterans, victims of motor vehicle accidents, and athletes. These patients often suffer from traumatic brain injuries (TBIs) and post-traumatic stress disorder (PTSD). To date, there are no effective pharmaceutical treatments for the combination of these disorders. Haley was inspired by the book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence by Michael Pollan. That is how she met Dr. Michael Hoffer, a neurotologist at the University of Miami Hospital who served 21years as a US Navy physician caring for many patients who suffered from TBIs and PTSD. They set out to analyze three drugs in particular: psilocybin, cannabidiol (CBD), and N-acetyl cysteine (NAC).
What excites me the most is that natural compounds like psilocybin, CBD, and NAC have shown promising results in treating brain injuries and psychiatric conditions, potentially changing the current treatment paradigm.
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To conduct this project, Haley and other lab members induced a blast injury in rats to create a TBI and exposed rats to predator (fox) urine at multiple time points to model PTSD. Rats and humans with TBIs and PTSD have been found to spend more time in the dark, have a heightened startle response, and have an altered auditory brainstem response. To see if any drugs could rescue the rats from tendencies related to their brain injuries, the injured rats were treated with psilocybin, NAC, CBD, a combination of NAC and psilocybin, a combination of NAC and CBD, or a placebo. The rats’ performance on several tests was then assessed. The rats were placed in a light-dark box, which is a box divided into a well-lit compartment and a dark compartment, and the time they spent in each compartment was measured. To assess the rats’ startle responses, a small sound was played, and the amplitude of the rats’ jump was measured. The rats’ auditory brainstem response was also measured by checking the cochlea (inner ear) of the rats to assess their hearing.
This is an ongoing project, but one major finding so far is that rats who received a combined treatment of either NAC and psilocybin or CBD and psilocybin spent significantly more time in the well-lit portion of the light-dark box than rats who received NAC alone, psilocybin alone, or placebo. One interesting observation was that in rats with a TBI caused by a blast, the combination therapies were more effective than in rats without TBI who were not blasted. One hypothesis for why this might be is that the blast may disrupt the bloodbrain barrier and allow the drugs to pass through and be more effective. This project is also going to clinical trials soon to see if these results are similar in humans. This study has immense potential to change the treatment for brain injuries. Haley hopes that the results will show that drugs such as NAC, CBD, and psilocybin can greatly improve the quality of life for patients with TBIs and PTSD. The next steps in Haley’s research are to look at how different doses of CBD affect rats with TBI and PTSD. Haley is currently a third-year medical student and hopes to apply to residency for otolaryngology this fall. She believes that a career in otolaryngology would provide her with an opportunity to treat children and adults who experience hearing loss, guiding them and their families through these diagnoses. Haley is looking forward to presenting this research at the Association for Research in Otolaryngology Midwinter Annual Meeting in February 2022 and writing a manuscript on this project as well. This study serves to further describe clinical characteristics and therapeutic distinctions between adolescents/young adults and older adult populations.
Haley Hullfish MD Class of 2023
Honors: Pathway of Emphasis in Health Law Mentor: Dr. Michael Hoffer, MD Activities: Assistant Project Manager for Big Pine Key DOCS fair, Project Manager for the Keys DOCS fair, Miami Street Medicine Director of Education and Training, Executive Director for Oral Head and Neck Cancer Awareness Week, Vice President of ENT Interest Group Future Goals: Otolaryngology
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Culturally-Informed Public Health Interventions with the Haitian-American Community in Miami by Sharon Hsieh
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I hope to work in minority communities in the future, so this provides a framework to educate any future clients or personnel in an effective manner.
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Logic Model for
aitian Americans represent one of the largest minority populations in Miami, Florida. While an increasing number of Haitian immigrants have assimilated into American society, a majority of the population still struggles with adapting to cultural norms. Some barriers they face include being burdened by financial hardship, language barriers, and having to navigate the legal, educational, and healthcare systems in a new environment. The COVID-19 pandemic has posed public health challenges for the population worldwide, but even more so for those who are disadvantaged. In particular, the pandemic has exposed the structural inequities that exist in the healthcare system. Hence, there is a dire need for tailored interventions to support minority populations during this pandemic.
Third-year MD/MPH students, Irene Goo and Lounah Pierre-Gilles, decided to create a culturallyrelevant, logic model that outlines public health interventions needed for the Haitian American community in Miami, Florida. Specifically, a logic model is a visual illustration of a program’s resources, activities, and expected outcomes. It is used to implement and evaluate a program. When asked about what prompted their decision to pursue this research project, Irene drew on her past experiences working with a national student-led organization called ContraCOVID in which she disseminated a Community Resources Guide for Miami Dade County with a goal to assist immigrant populations dealing with financial and health burdens of the COVID-19 pandemic. She expressed that there is a paucity of literature that provides guidance to minority communities during a time of heightened need. Therefore, Irene reached out to Lounah and they worked together to evaluate how to properly guide future efforts to reach the Haitian- American community. Concurrently, Lounah was inspired by her heritage as a Haitian- American living in South Florida. Lounah added, “During this pandemic, I have seen first-hand the importance of effective information dissemination to minorities.”
This research is critical as it elucidates the cultural aspects that affect health literacy and access among the Miami Haitian- American diaspora. The logic model also provided a framework to inform healthcare professionals about the common experiences of the Haitian community while dealing with the COVID-19 pandemic and health care in general. When asked about the broader implications of the study, Irene and Lounah answered, “Future public health messaging should focus on this cultural narrative of caring for others as a method to introduce and explain health behavioral changes such as social distancing.” Indeed, this project will help facilitate more sustainable changes toward addressing the Haitian community’s healthcare disparity. This project was presented at the 2021 AMA Research Challenge. Looking forward, Irene stated that the project has helped her recognize the importance of understanding the needs, dynamics, and culture of the community she serves. Similarly, Lounah hopes to work with minority communities in the future, and this project provides a framework to educate healthcare professionals and patients in an effective manner.
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This project really helped me to recognize the imperative nature of understanding the community I am trying to help - even the best intentions can end up fruitless without proper understanding of the needs, dynamics, and culture of the community. In the future I hope to be more intentional in understanding my patient population as I become a practitioner.
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Under the mentorship of Dr. Alberto Caban Martinez and staff members from the Center of Haitian Studies (CHS), Irene and Lounah implemented a survey with questions about the community’s demographic information, access to care, health literacy, and health beliefs. They asked the community members to complete the survey and subsequently analyzed the data to create the logic model. They found that language was one of the primary barriers to health as 90.7% of the respondents primarily spoke Creole. Therefore, community leaders such as church pastors served as trusted sources of information. Additionally, qualitative analyses identified themes of difficulty following CDC guidelines due to cultural norms. Specifically, self-quarantine at home was demanding due to a lack of space and social distancing was challenging as it was customary for people to live in multi-family households within close quarters. Despite the multifaceted barriers to health, the Haitian population expressed strong emphasis on caring for others and the idea of a collective good.
Irene Goo (left)
MD/MPH Class of 2023 Honors: Presented research at the AMA Virtual Research Challenge 2021 Mentor: Dr. Alberto Caban Martinez, DO, PhD, MPH, CPH Other Activities: Human Rights Clinic, Social epidemiology research, DOCS, Mindful Medicine Club Future Goals: Irene is considering a career in pediatrics or hematology/oncology. She would like to have a career in which she can continue public health research/interventions for her local community.
Lounah Pierre-Gilles (right) MD/MPH Class of 2023
Honors: Presented research at the AMA Virtual Research Challenge 2021 Mentor: Dr. Alberto Caban Martinez, DO, PhD, MPH, CPH Other Activities: RMC ShopDocs, DOCS Center of Haitian Studies Future Goals: Lounah hopes to go into internal medicine in the future and split her time between the hospital and clinic.
The Medical IBIS | 12
How COVID-19 Changed Otolaryngology by Jake Langlie
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s surgeons of the airway, otolaryngologists are at high risk of contracting COVID-19. To prioritize safety, telemedicine, virtual medical education, and alternative experiences to training were used to adapt otolaryngology to the COVID-19 pandemic. Jake Langlie, a second-year medical student, was eager to pursue a residency in otolaryngology and wanted to investigate the ripple effects caused by the changes in the field. Along with his mentor, Dr. Adrien Eshraghi, M.D., Jake decided to perform a primary literature review on the pandemic’s impact on medical education, resident training, and telemedicine implementation in the field of otolaryngology. A thorough literature review of the PubMed, Cochrane, and MEDLINE databases was performed for publications in May of 2021. 209 articles were retrieved, and 73 articles underwent full-text review; 47 studies were included in the qualitative synthesis for the article. The selected articles emphasized three points: how medical education in otolaryngology was tailored to the COVID-19 pandemic, how residency programs changed for otolaryngology recruitment, and how telehealth in otolaryngology impacted the provider and patient.
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The literature review showed how residents had to adapt to alternate learning experiences of patient care including virtual surgeries, synchronous didactic sessions, and telemedicine. In terms of residency recruitment, medical students networked with programs through social media and adapted to cost-efficient virtual interviews. Regarding telehealth, patients loved following up with their physicians from the comfort of their home. However, the widespread and rapid implementation of telemedicine led to increased stress and burnout among otolaryngology providers and residents. Jake believes that the large scale and forced speed of multiple online alternatives merits further prospective studies on their long-term effectiveness and continued use. Regardless, Jake is proud that the medical community overcame the early-stage struggles of telemedicine implementation and that the groundwork was laid for responding to future obstacles. “This project helped me realize how adaptable the field of otolaryngology is and made me excited to hopefully be able to join the field in the future,” Jake said. “My favorite part of this project was seeing how institutions, both nationally and internationally, was able to adapt their practice for the safety of both providers and patients.” Jake is currently in the process of preparing his project for manuscript submission. When asked if he had any advice, he said that students interested in research should have a schedule of how much time they can devote to their research, their studies, and their hobbies. He also encourages preclinical students to not get disheartened if the projects they work on do not come to full fruition.
Jake Langlie Successful research teaches you perseverance and time management; it is more than just producing abstracts and papers.
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MD Class of 2024 Honors: 1st Place Poster among Residents and Medical Students – 2021 Florida Combined Otolaryngology Meeting Mentor: Dr. Adrien Eshraghi, MD, MSc, FACS, Professor of Otolaryngology, Neurological Surgery, Biomedical Engineering and Pediatrics Other Interests: ENT Interest Group, CHAMP Mentorship Program, SIPS Interest Group, OHANCAW, University of Miami Global Surgery Alliance, DOCS Future Goals: ENT residency
Redefining the Gold Standard: Pre-Operative MRIs for Early Stage Breast Cancer
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eter Borowsky’s passion for research developed early on. Like many medical students, his journey into research began during his undergraduate years. For Peter, research not only supplements his clinical knowledge but also helps him better understand the nuances of care that he hopes to provide as a surgeon.
by Amirah Rashed
During his 3rd year while on his surgical oncology rotation, Peter began attending surgical oncology research meetings. There, he discovered the novel projects helmed by Dr. Kristin Rojas, M.D., FACS. Dr. Rojas, an assistant professor of surgical oncology at Sylvester Comprehensive Cancer Center and the DeWitt Daughtry Family Department of Surgery, was particularly interested in working with REDCap, a webbased data capture application used for clinical research. Luckily, Peter had REDCap experience from his gap year position that prepared him for his role in this project working under the mentorship of Dr. Rojas.
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Research provides an opportunity to develop skill sets that you may not get in your medical education, residency training, or even early career, and those skill sets can be things like data collection, statistical analysis, or learning how to write a manuscript.
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The project was a retrospective cohort study of patients diagnosed with breast cancer. When patients are diagnosed with breast cancer, they go through a standard workup in which some patients receive MRIs and others do not. Peter analyzed the differences in mastectomy rates between these two groups, noticing that patients who received preoperative MRIs were twice as likely to undergo mastectomy – instead of a less invasive lumpectomy – in comparison to patients who did not receive preoperative MRIs. Considering MRIs have long been the gold standard for preoperative workups, Peter and his team wonder if their findings could lead to changes in the standard of care.
This past November, he presented his findings at the Sylvester Comprehensive Cancer Center Research Symposium. He also is preparing to present his project at the 17th Annual Academic Surgical Conference in February and publish his work later this spring. With the help of Dr. Rojas, Peter’s ultimate goal is to create a national consensus guideline regarding the use of MRI in preoperative workup of patients with early-stage breast cancer. He hopes his findings will better highlight the advantages and disadvantages of preoperative MRI, thereby ultimately preventing unnecessary surgery and reducing the toll surgery can have on breast cancer patients. When asked about his favorite aspect of this project, Peter talked about his mentor, Dr. Rojas. Having a mentor who supports his goals, advocates for his success, challenges him to think critically, and cultivates his ability to lead a team of others. As for advice for other students considering research, Peter stresses the importance of time management, organization, and discipline in order to balance school and personal life. Currently, he is training to compete in an Iron Man triathlon this coming May.
Peter Borowsky MD Class of 2022
Honors: Oral presentation at Academic Surgical Congress 2022; Poster at University of Miami Sylvester Comprehensive Cancer Center 2021 Annual Retreat Mentor: Dr. Kristin Rojas, MD, FACS Other Interests: Former DOCS Patient Navigation Access Coordinator Future Goals: General surgery residency
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Cutting through the Kidney Supply-Demand Mismatch by Amirah Rashed
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fter completing her Masters in Biomedical Sciences at the University of Miami Miller School of Medicine in 2019, Marina Tabbara spent a year working as a Patient Care Technician at a dialysis clinic. There, she was exposed to the fields of nephrology and transplant surgery and got to work closely with patients. She began to understand how taxing it can be for dialysis patients to receive care. In addition to managing their illnesses every day, patients have to come in for dialysis three times a week while they go through the difficult process of getting on a kidney transplant list. Marina’s time in the dialysis clinic helped her develop an interest in nephrology and led her to participate in the University of Miami Kidney Innovative & Interdisciplinary Medical Education in Research Activities (UM-KIIMERA) Program. KIIMERA exposes students to basic, clinical, and translational science research opportunities within the field of nephrology. Through UM-KIIMERA, Marina was matched with Dr. Gaetano Cianco, M.D., M.B.A., FACS, the chief medical officer, chief academic officer, and the director of the kidney & kidney-pancreas programs at the Miami Transplant Institute. Dr. Cianco is also the director of advanced uro-oncology surgery at the UMMSM. Marina started off her summer by writing case reports in Dr. Cianco’s lab and eventually took responsibility for a larger project. In the transplant world, an ideal living-donor kidney would have a single renal artery. Unfortunately, this is not always the case, and when encountering kidneys with multiple renal arteries (MRA), complex renovascular reconstructions and anastomosis techniques can be necessary for successful transplantation. Marina conducted a retrospective medical record review of Dr. Cianco’s patients, analyzing recipient and donor characteristics, operative data, type of reconstruction, and recipient outcomes. She was interested in measuring the incidence of developing delayed graft function (DGF) and/or a vascular or urological complication within 12 months post-transplant in complex versus simple renovascular transplantations.
Marina Tabbara MD Class of 2024
Mentor: Dr. Gaetano Cianco, MD, MBA, FACS Other Interests: DOCS Cholesterol/Glucose Station Manager Future Goals: General surgery residency, interested in transplantation and vascular surgery
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The whole idea is being able to utilize as many available resources as you can, especially in a day and age where the supply and demand between organs is very wide.
Marina found that the complex reconstruction techniques needed to create a single renal artery ostium in allografts with MRA had acceptable warm ischemic times, with no increased risk of post-operative complications. It has been thought that encountering MRA in a donor kidney can be harmful for the survival of the kidney with negative effects on recipient outcomes. Marina’s work demonstrated how the use of certain surgical procedures in kidneys with MRA can produce outcomes analogous to those in recipients of kidney transplants that have a single renal artery. Through this project, Marina hopes to enable surgeons to broaden their skill set for undertaking complex reconstruction techniques so that valuable donor kidneys are not wasted. Moving forward, she plans to continue to work on researching and promoting awareness for novel and unique ways to salvage donor kidneys. Most recently, she worked on a case report detailing Dr. Cianco’s work in performing a kidney transplant using a donor kidney from a patient with polycystic kidney disease. Marina recalls that her favorite part of conducting this project was learning how to write and present her results clearly with her community, enhancing the results’ impact and message. She also speaks fondly of her mentor, Dr. Cianco, as an amazing interdisciplinary surgeon who inspires her as she plans to go into general surgery and later pursue her interests in vascular surgery and transplant. She will be presenting her findings at the American Society of Transplant Surgeons 22nd Annual Winter Symposium. Marina admits that a lot of her time is occupied by research and academics, but she finds joy in spending time working on these projects she is so passionate about. When she takes a break, she enjoys relaxing in Brickell Key and offers this advice, “When you have a free moment, take advantage of it and go outside.” She has maintained her wellness throughout medical school by making it a priority to spend time with family and friends, often connecting over a home-cooked meal, like her famous risotto, and pursuing rewarding projects that can help the patients that inspired her career in the first place.
The Medical IBIS | 16
Extraskeletal Myxoid Chondrosarcoma—Clinical Features and Overall Survival by Sharon Hsieh
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ince his first year of medical school, Jeffrey Brown has taken on research opportunities with the orthopedic oncology group at UM. Through the Journal Club, Jeffrey met Dr. Juan Pretell, who has guided his research endeavors since then. Jeffrey expressed immense interest in studying sarcoma since learning about this rare form of cancer in medical school. Sarcoma is a rare and heterogeneous group of malignant pathologies of mesenchymal origin, which consist largely of bone and connective tissue. Consequently, his passion propelled him to accumulate extensive experiences studying sarcoma, which range from the arena of basic science to translational and clinical research. As a current Sarcoma Research Fellow at the Huntsman Cancer Institute at the University of Utah, Jeffrey received a grant to further his research for the 2021-2022 academic year. This one-year fellowship is pivotal to his medical school career as Jeffrey wants to pursue an orthopedic surgery residency and complete a fellowship in musculoskeletal oncology. Therefore, contributing to academic research is an important component of his career development both as a clinician and scientist. Extraskeletal myxoid chondrosarcoma (EMC) is a rare form of soft tissue sarcoma characterized by a unique chromosomal translocation involving the NR4A3 gene on chromosome 9. It is most frequently diagnosed in the proximal extremities of older adult males and is notable for its indolent growth with a predilection for local recurrence and metastasis. Poor prognostic factors include old age, large tumor size, high histologic grade, and ineligibility for surgery. Currently, EMC is managed with wide
resection, with recent investigations supporting the utility of adjuvant radiation and chemotherapy. Yet, like other soft tissue sarcomas, conventional chemotherapy and radiation did not seem to discernibly improve overall survival. Through the use of the Surveillance, Epidemiology, and EndResults (SEER) database, Jeffrey and his co-authors searched for cases of EMC diagnosed between the years 2004-2015. They were able to identify presenting features of EMC and describe survival outcomes. They found that the 5-year overall survival was 76.5%. However, the prognosis was worse for elderly patients with larger tumor sizes, patients without surgical intervention, and patients with tumors with high histologic grade, metastatic or nodal spread, and those located in the pelvis region. Interestingly, metastasis did not significantly predict worse survival, and radiotherapy had no discernible influence on survival either. While they did not find a survival benefit from conventional chemotherapy and radiation in this study, Jeffrey noted that there are novel therapies being tested in this type of sarcoma that may show therapeutic benefit. Jeffrey noted that “even though sarcomas are rare…. the suffering for individuals diagnosed with sarcoma is very real, and unfortunately, therapeutic options are limited. This project serves to raise attention to sarcoma in general and describe features and outcomes of a rare subtype— extraskeletal myxoid chondrosarcoma.” Currently, Jeffrey and co-authors have produced a manuscript that is in the review process for publication. When asked about the broader implications of the project, Jeffrey added, “This project serves as a valuable resource for clinicians as well as myself personally, as I hope to be taking care of patients with this type of malignancy in the future. It also serves as a point of reference for similar sarcoma studies I may perform in the future.”
Jeffrey Brown MD Class of 2023
This project serves as a valuable resource for clinicians as well as myself personally, as I hope to be taking care of patients with this type of malignancy in the future. It also serves as a point of reference for similar sarcoma studies I may perform in the future.
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Honors: Sarcoma Research Fellow at the Huntsman Cancer Institute at the University of Utah; Received sarcoma academic research grant Mentor: Dr. Juan Pretell, MD Other Activities: San Juan Bosco Clinic, Anatomy TA, Orthopaedic Surgery Interest Group, Trauma Interest Group, ESRF committee member Future Goals: Orthopedic Surgery
Protective Effects of the Flu Vaccine Against SARS-CoV-2 by Amy Thein
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...[B]eing able to tell people about the influenza vaccine and its effect on severe COVID and watching as they are mesmerized by it, and above all, hearing stories of people in El Salvador that have never gotten a flu vaccine go and get their flu shot to have increased protection against coronavirus. This shows me that our research is impactful!
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owards the beginning of the COVID-19 pandemic, many wondered what the effects of battling SARS-CoV-2 would be like, along with dealing with the influenza virus. Fourth-year medical student Susan Taghioff, however, wondered whether the influenza vaccine could be protective against patients with severe COVID-19 while undergoing surgery. Her interest in surgery and global health led her to Dr. Devinder Singh, M.D., Chief and Program Director of Plastic and Reconstructive Surgery and professor of clinical surgery. Under his mentorship, the research team sought to determine whether the influenza vaccine could be protective against postoperative outcomes in patients with perioperative COVID-19. Dr. Singh’s team used a novel network of EMRs called TriNetX to create a large retrospective cohort comparison study, starting with two groups totaling 43,580 patients who were COVID-19 positive on the day of surgery. The first group received the influenza vaccine six months to two weeks prior to SARS-CoV-2-positive diagnosis, while the second group did not. Using propensity score matching, the researchers balanced the groups for age, race, obesity, comorbidities such as diabetes and cancer, and socioeconomic and lifestyle differences, including access to healthcare, tobacco use, and diet. They gathered data on postoperative outcomes by analyzing common procedural terminology (CPT) codes. They found that COVID-19 positive patients in the group who received the influenza vaccine had better postoperative outcomes compared to patients in the group that did not receive the influenza vaccine, including a 52% lower risk of sepsis, 26% lower risk of death, and lower risks of deep vein thrombosis, surgical incision dehiscence, heart attack, infection, stroke, and pneumonia within 120 days of surgery. Notably, the team cautions that the influenza vaccine is not a substitute for COVID-19 vaccination and strongly
recommends that everyone get both their flu and COVID-19 vaccines. These findings provide hope for another method to protect against severe COVID-19, particularly for countries with limited access to coronavirus vaccines. The research group presented their research at the American College of Surgeons (ACS) Owen Wangensteen Scientific Forum in October 2021. The team also won the Plastic Surgery Research Day Award and a silver medal in the department-wide Omaida Velazquez Research Day Award for this project. The research group has published another paper on the impact of influenza vaccination in COVID-positive patients that was featured in multiple news outlets, including The Times, The Guardian, Daily Mail, Yahoo News, Fox News, and Newsweek. The team recently had their abstract for this project published with the hopes to promote this latest manuscript on a global scale. Susan says that her favorite part about this project has been seeing the impact of her research on global populations. She recommends that aspiring medical student researchers find a mentor and an older medical student as early as possible, and that “if you can’t find anyone, you can always reach out to me!” She wants younger medical students to “remember everyone is in their own lane and never compare yourself to others, just be the best you can be… Lastly, when you’re given a chance to impress someone through research, you should always give 110% effort!” In her free time, Susan likes to travel, cook, do yoga, and play with her baby niece. Given Susan’s curiosity and dedication, hopefully, her work and that of other talented researchers can allow us to move toward better COVID-19 outcomes and improve patient health and education globally.
Susan Taghioff MD Class of 2022
Honors: Oral presentation at the 2021 American College of Surgeons Owen Wangensteen Scientific Forum Mentor: Dr. Devinder Singh, MD Other Activities: Students Interested in Plastic Surgery, music, jogging, yoga Future Goals: Plastic and Reconstructive surgery with an emphasis on global surgery
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A Murine Model of RadiationInduced Skin Fibrosis Suggests Response to Injury Extends Beyond the Treatment Field by Amy Thein
Under the mentorship of Dr. Marjana Tomic-Canic, Ph.D., Vice Chair of Research at the University of Miami Miller School of Medicine’s Department of Dermatology and Cutaneous Surgery, and Dr. Rivka Stone, M.D., Ph.D., Assistant Professor at the Phillip Frost Department of Dermatology and Cutaneous Surgery, he found a research lab that let him pursue his dual interests. A subset of patients who undergo radiation in oncology and interventional radiology settings develop
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progressive skin fibrosis, a debilitating disease that can lead to long-term disability and impaired quality of life. This complex topic requires a multidisciplinary team science approach that includes collaborators from both the Sylvester Cancer Center and Surgery Department. In the lab, Nathan sought to utilize a murine (mice) model in which fibrosis is induced by high-dose irradiation of skin in the hope of creating a model of radiation-induced fibrosis to study its impacts. The team irradiated mice and compared the irradiated skin with adjacent non-irradiated skin, using the non-irradiated mice as controls. The researchers successfully induced skin fibrosis following high-dose radiation treatment, indicated by increased dermal thickness and hydroxyproline (collagen) content. Interestingly, although the irradiated and non-irradiated areas of each mouse appeared phenotypically distinct, RNAsequenced profiles showed fibrosis-associated genomic changes and collagen/matrix induction that extended well beyond the immediately radiated field. This suggested that caution should be exercised in patients undergoing radiation to minimize the off-target effects of radiation.
Whenever I find that specific niche, I’ll know exactly where I can develop expertise and really propel the field of dermatology forward.
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hile many of us may find that life initially pulls us in numerous directions, in the end, the different paths often come together. For Nathan Balukoff, this was no different. Originally certain he would pursue a career in internal medicine, his career goals first pivoted toward oncology after being exposed to the field by his mother, a pediatric oncologist nurse. He enjoyed research, so before medical school, he spent time immersed in oncology and earned a Ph.D. in cancer biology at the University of Miami. It wasn’t until his third-year clinical rotations though that Nathan uncovered his true passion, dermatology. His interests were multifaceted, and he fell in love with the relationship between wound healing and cancer, connecting all the strings that originally seemed unrelated.
Nathan Balukoff MD Class of 2022
Mentors: Dr. Marjana Tomic-Canic, PhD, and Dr. Rivka Stone, MD, PhD Other Interests: Running, Mindfulness, Meditation Future Goals: Nathan hopes to one-day head his own lab focused on 80% research and 20% clinical work
The team hopes to explore further areas of research to understand what different types of skin may be more susceptible to fibrosis and the timetable of radiation-induced genomic changes and to eventually apply this research to ex vivo studies using human skin samples. Nathan has presented this research at the Innovations in Wound Healing conference and plans to present at another conference in April 2022 at the Symposium on Advanced Wound Care (SAWC) & Wound Healing Society (WHS). The Tomic and Stone lab allowed Nathan to marry his passions of dermatology and oncology and conduct research in a field that could provide real help to alleviate suffering in patients. Nathan hopes to build on this experience and carve his own path at the intersection of dermatology and oncology, stating that “whenever I find that specific niche, I’ll know exactly where I can develop expertise and really propel the field of dermatology forward.” He is passionate about patientcentered research and aspires to join a combined postdoctoral/residency program. He emphasized how great his mentors are at fostering physician-scientists and promoting
clinically oriented, patient-centered research, and hopes to one-day head his own lab, managing a team dedicated to patient-focused research. Nathan advises that any aspiring medical student researcher maintain balance by always focusing on personal well-being and having a good schedule. Personally, he always makes time to run the Venetian Causeway and is proactive in his studies, allowing him to manage his time well. Regarding finding research opportunities, Nathan recommends starting as early as possible and reaching out to different people. He notes that academic medicine is a field about connections, and that “Miami is a great place because our dermatology department is superb and we have a really prestigious cancer program, so we have the best of both worlds. Everyone's very collaborative and excited to do research here, so it's a great environment.” With great mentors like Dr. Marjana Tomic-Canic and Dr. Rivka Stone and passionate students like Nathan, the University of Miami Miller School of Medicine has every reason to be optimistic about what the future holds.
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HML-6 as a Potential Novel Driver of Glioblastoma
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by Shreya Ingle
Glioblastomas are malignant brain tumors of the brain that spread rapidly and almost inevitably recur within nine months of surgical resection, chemotherapy, or radiation. The median survival for patients with glioblastomas is about one year, so identifying unique drivers of glioblastomas and how these can be targeted for treatment is crucial to improving life expectancy.
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Throughout human history, our species has been infected with many different viruses. Some of those were embedded into our ancestors’ genomes and passed down to future generations. This is how Human Endogenous Retroviruses (HERVs) arose. Many of these HERVs are methylated or silenced. However, they have been shown to reactivate in many cancers, including colorectal and renal cancer, which have documented HERV expression. Vaidya and Dr. Shah noticed a gap in the literature on HERV expression in glioblastomas and decided to investigate. Vaidya combined basic science and computer programming techniques to analyze opensource, deidentified gene expression data. Using R programming, Vaidya processed raw sequencing data to see which HERVs were differentially expressed in cancer cells compared to regular cells. He also looked at if various genes that overlap HERVs are differentially modulated in cancer cells versus normal cells.
We used a hybrid approach between computational biology and in vitro traditional lab techniques. It was really amazing to be able to confirm a lot of what we saw computationally. Traditionally, that’s been a weakness of computational biology - a lot of it is conjecture until you can prove it in the lab.
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aidya Govindarajan, Class of 2023, always had an interest in the intersection between bioinformatics and clinical medicine. He spent the summer before medical school teaching himself programming and researching how to apply different programming languages to clinical research. So when he found out that Dr. Ashish Shah with the University of Miami Department of Neurosurgery was using computational biology to understand glioblastomas, he was eager to contribute.
Research has shown that one specific HERV known as HML-6 encodes a small protein on the viral envelope. It has been hypothesized that HML-6 can affect the potential of a cell becoming cancerous. The first main finding of Vaidya’s project is that HML-6 is differentially expressed in glioblastoma cells and patient-derived samples. Additionally, the more invasive tumors tend to have higher expression of HML-6. Vaidya’s research found that more aggressive cell lines had lower methylation at the spots where HML-6 is found in a highly aggressive cell line. When the data was plotted, there was a high correlation between low methylation and the location of HERVs. This showed that differential methylation was associated with differential HERV expression in patient-derived samples of glioblastoma cell lines. For the second main finding, Vaidya took clinical data and looked at the expression of a protein product of HML-6 called ERVK3-1. He found that patients with higher ERVK3-1 expression had lower overall survival than people with lower ERVK 3-1 expression. His computational findings were confirmed by PCR performed on patient-derived glioblastoma samples and showed elevated levels of HML-6. More invasive cancer samples also stained darker for HML-6 than the less invasive samples. This research and its findings have major implications for glioblastoma research and open a new avenue in our understanding of tumor biology with the idea that HML-6 and ERVK3-1 could be drivers of oncogenesis by preventing immune cells from fighting the tumor, explaining why some tumors are more invasive. Vaidya is currently third-year medical student hoping to apply to residency in neurosurgery. He hopes to continue researching the HML-6 gene and its protein product into and beyond residency. “If we can show that the ERVK3-1 does have some impact in terms of driving the tumor or preventing adequate immune response to the tumor, we have a really promising target to silence,” says Vaidya. He would like to thank Dr. Shah for giving him the opportunity to work on this project and for being an amazing mentor along the way. Vaidya hopes this research is a step in the direction of identifying new targets for glioblastoma treatments in order to help his future patients.
Vaidya Govindarajan MD Class of 2023
Mentor: Dr. Ashish Shah, MD Activities: Clinical Skills Training Director, Football Future Goals: Neurosurgery, Academic Research
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