United States

Background
Preterm labor is the leading cause of infant mortality and morbidity worldwide, yet no pharmacological treatments currently exist to combat it. Although potentially effective therapies exist to suppress undesirable uterine contractions, these drugs often transport across the placental barrier, leading to adverse consequences on the developing fetus. Formulation strategies to limit fetal exposure may enable the safe and effective use of currently approved drugs for the prevention of preterm birth. Poly(lactic-co-glycolic) acid (PLGA) is a biocompatible copolymer that is used in a variety of drug formulations and in ‘dissolvable’ sutures. We hypothesize that optimally sized PLGA particles formulated with an anti-tocolytic will limit placental transport and suppress uterine contractions.
Methods
Therefore, we synthesized PLGA particles loaded with cargo and tested two formulations via an oil-in-water emulsion fabrication technique. One formulation used dichloromethane (DCM) with polyvinyl alcohol (PVA), and the other used ethyl acetate (EtAc) with D-α-tocopheryl polyethylene glycol succinate (Vitamin E-TPGS); both have been reported to successfully prepare PLGA particles in the target diameter range. Further studies to prove model translatability were performed, including kinetic release using two common tocolytics (indomethacin and nifedipine), in-vivo biodistribution, and ex-vivo experiments using murine uterine strips.
Results
The resulting EtAc/Vit E-TPGS emulsion produced average particle diameters of 1350 (± 64.5) nm (PDI: 0.3037). However, this formulation was more polydisperse compared to the DCM/PVA emulsion with average particle diameters of 1251 (±300.4) nm (PDI: 0.2020) that also exhibited acceptable day-to-day variability, ranging from 1137 to 1734 nm. We showed successful drug encapsulation in the absence of variation in particle size for indomethacin 1267 (± 82.72) nm and nifedipine 1142 (± 1.155) nm. Both tocolytics show the capacity for sustained release with total cumulative release of indomethacin (30 days) and nifedipine (24 days). In-vivo biodistribution studies demonstrate localization of the targeted PLGA particles to the uterus, and ex-vivo studies present a clear effect of the tocolytic drug after loading. 
Conclusion
Through optimized physiochemical characteristics and clinical translation, this formulation has the potential to effectively inhibit preterm labor contractions in a novel delivery system. Next steps include decoration of particles with a uterine-selective antibody corona. The function of drug-loaded PLGA particles to inhibit uterine contractions will be tested in a model system with human tissue in organ baths. Results of these studies will be used to refine the drug to PLGA ratio and the PLGA characteristics to optimize efficacy and toxicity.

2025 AMA Research Challenge – Member Premier Access

Developing a Nanoparticle Drug Delivery System to Treat Preterm Labor

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Background
The use of low-dose colchicine in the orthopedic treatment of non-crystalline arthropathy conditions is not well-explored. Colchicine is an antimitotic drug that inhibits neutrophils and has demonstrated anti-inflammatory properties. Colchicine lacks many of the adverse effects associated with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), including upper gastrointestinal bleeding, nephrotoxicity, and hypertension exacerbation. This study evaluates the safety and effectiveness of low-dose colchicine as an alternative to NSAIDs in the conservative treatment of orthopedic patients.

Methods
A retrospective chart review was conducted at a single orthopedic clinic from March 2024 to February 2025. Patients treated for orthopedic conditions with colchicine 0.6 mg orally once daily, who had patient-reported Visual Analog Scale (VAS) pain scores recorded at the initial and first follow-up visit, were included. Patients with crystalline arthropathies were excluded. Descriptive analyses were performed to assess the mean and standard deviation of VAS-pain scores before and after treatment. A subgroup analysis was performed after excluding patients who received procedures or injections at the initial visit to evaluate the impact of this confounding variable.

Results
Of 306 patients reviewed, 144 met the inclusion criteria. The mean age was 62.93 ± 14.21 years (101 females, 43 males), with an average follow-up of 56.21 ± 35.82 days. The mean VAS-pain scores at the initial and first follow-up visit were 6.76 ± 2.33 and 5.35 ± 2.88, respectively. The mean reduction in pain (follow-up - initial) was -1.42 ± 3.02. Two patients reported side effects, including joint pain and gastrointestinal symptoms. No serious adverse events were reported. After excluding patients who had procedures or injections (n = 117), the mean VAS-pain scores were 6.53 ± 2.40 initially and 5.35 ± 2.99 at follow-up. The mean reduction in pain for this group was -1.18 ± 3.08.

Conclusion
These results suggest that low-dose colchicine may represent a safe alternative to NSAIDs in the conservative treatment of orthopedic patients. While a modest reduction in pain scores was observed, further controlled studies with larger cohorts and longer follow-up are needed to determine efficacy and statistical significance.


Low-Dose Colchicine as an NSAID Alternative in Orthopedic Patients: A Retrospective Review


Background: Perioperative opioid prescriptions have been shown to increase the risk of persistent opioid use in opioid-naive patients undergoing gastrointestinal surgery. However, there remains a lack of literature that evaluates whether national opioid prescribing trends and opioid-related outcomes may differ with more minimally invasive gastrointestinal surgeries as stratified through the endoscopic and laparoscopic approaches. This study evaluates the association between perioperative opioid use and persistent opioid use in opioid naïve patients receiving minimally invasive gastrointestinal surgeries involving either an endoscopic or laparoscopic approach. 

Methods: We conducted a retrospective cohort studying using data from the TriNetX US Collaborative network, including 3.2 million opioid-naive patients undergoing GI procedures from 2016 to 2024. Patients with a perioperative opioid prescription, as defined by an opioid prescription ranging from 1 month prior to surgery to 3 days after surgery, were propensity score-matched 1:1 to controls. Our primary outcomes were persistent opioid use within 30 days and 180 days postoperatively. 

Results: The incidence of opioid use has decreased. A perioperative opioid prescription was significantly associated with increased opioid use within 30 days across all surgical approaches: endoscopic and laparoscopic. Periopeapersistent opioid use, emergency department visits, opioid overdose, opioid dependence, and all-cause mortality

Conclusions: Perioperative opioid prescriptions are strongly associated with persistent opioid use at both 1 and 6 months after endoscopic and laparoscopic GI surgery. In endoscopic cases, opioids were also linked to higher risks of overdose, dependence, ED visits, hospitalizations, and mortality. Laparoscopic patients showed a more nuanced risk profile—persistent opioid use was consistently higher, but secondary outcomes varied, with some evidence of reduced inpatient stays and mortality. These findings highlight the need for procedure-specific opioid stewardship strategies to minimize harm while ensuring adequate pain control.


Evaluation of National Opioid Prescribing Trends and Outcomes in Gastrointestinal Surgery- Endoscopic and Laparoscopic Approaches

Attention-deficit hyperactivity disorder (ADHD) is the most common neurocognitive disorder diagnosed in children, with an estimation of six million children aged 3-17 diagnosed with ADHD. Stimulants are the first-line treatment for children with ADHD but may cause adverse effects. This study aims to shed light on non-pharmacological approaches to treating children with ADHD, specifically exercise and dietary modifications. This literature-based review evaluated current research on PubMed focusing on the impact of exercise and dietary modifications as forms of treatment for ADHD. Though studies differ on what symptoms are most improved, exercise was found to be cost-effective and beneficial in ADHD symptom management. Of note, hyperactivity and aggressive behavior improved in children with ADHD after a yoga regimen was implemented in one study. In addition to exercise, the literature review found that a healthy diet consisting of vegetables and fish is the recommended choice for aiding in ADHD symptom management. Omega-3, zinc, iron supplementations, and dietary interventions such as few foods diet (FFD) and a polyunsaturated fatty acids (PUFA) diet, are not recommended due to inconsistent effects on reducing symptoms.

Effective Non-Pharmacological Options for Managing ADHD in the Pediatric Population

Background
->Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a severe complication of pulmonary embolism (PE) characterized by by non-resolving thrombi and progressive vascular remodeling that fails to resolve and transforms into fibrotic tissue, permanently occluding pulmonary arteries.
->While inflammation is implicated, the role of specific immune cells, particularly monocyte subsets, in thrombus persistence is unclear.

Introduction
Monocytes act as immune gatekeepers, and the disrupted coordination of these subsets impairs thrombus resolution and establishes an immune–fibrotic niche, a hallmark of CTEPH.
They exist as three major subsets:
-Classical monocytes (CM; CD14⁺⁺CD16⁻)
-> Inflammatory and rapidly recruited to sites of injury. 
-> Cells rely on C-C Chemokine Receptor Type 2 (CCR2), which enables their mobilization from the bone marrow into the bloodstream.
-Intermediate monocytes (Int-M; CD14⁺⁺CD16⁺) 
-> Transitional state between CM and NCM.
-> Act as a Potent antigen presentation and secrete inflammatory cytokines (TNF-α, IL-1β, IL-10)
-Non-classical monocytes (NCM; CD14⁺CD16⁺⁺) 
-> Patrol the endothelium and are involved in tissue repair and remodeling.
-> Their development depends on the transcription factor Nuclear Receptor Subfamily 4 Group A Member 1 (NR4A1).
We employed a partial inferior vena cava (IVC) ligation model in mice to mimic thrombosis with incomplete resolution leading to fibrotic residual clot, analogous to human CTEPH for translational implications(Fig.1).
For translational validation, we analyzed human PTE specimens and peripheral blood from CTEPH patients(Fig.2).

Methods
In the Murine model:
A Partial Inferior vena cava ligation was performed in Wild-type C57BL(B6)and genetic knockouts(KO) lacking CM(CCR2KO), and the absence of NCM (NR4A1KO) mice. Thrombi and IVC wall were harvested at acute (Days 1–2), subacute (Day 7), and chronic (Day 14) timepoints to assess weight(mg), length(mm), and vein-wall fibrosis via Masson’s trichrome (% collagen).
Human CTEPH Patients:
-Spatial transcriptomics (ST) using the 10x Xenium platform was conducted on:
- > 3 CTEPH tissue sections from pulmonary thromboendarterectomy(PTE).
->2 healthy pulmonary artery (PA) tissues from donor lungs
-Peripheral blood monocytes were isolated from 20 CTEPH patients with PTE and 10 controls.
->CM, INT-M, and NCM were sorted and quantified via flow cytometry.
->Bulk RNA sequencing was performed on classical monocytes to identify differentially expressed genes (DEGs) and pathways. 

Results
-In mice, both CCR2KO (CM-deficient) and NR4A1KO (NCM-deficient) mice exhibited accelerated thrombus formation and impaired resolution compared with B6(WT) controls (Fig.3A). 
-Thrombus weight remained elevated through Day 14 (CCR2KO vs B6, p = 0.02; NR4A1KO vs B6, p = 0.005), with only 33–47% resolution vs ~60% in B6 (Fig.3A).
Thrombus length decreased faster in KOs, reflecting compaction without degradation (Fig.3B).
-Histology showed a 1.8-fold increase in collagen deposition in NR4A1KO mice at Day 14 (p < 0.001), identifying NCMs as antifibrotic regulators of late thrombus remodeling.(Fig.4).
-Two-way ANOVA confirmed significant genotype (p = 0.028), time (p < 0.0001), and interaction (p < 0.0001)effects.
-In human CTEPH, spatial transcriptomics and RNA-seq revealed a monocyte-enriched fibrotic microenvironment composed of monocytes, macrophages, fibroblasts, and endothelial cells.
-Classical monocytes displayed >2,000 DEGs, including CTSG, MS4A3, FOXI2,AREG, denoting pro-inflammatory and profibrotic activation.
-Spatial mapping localized these monocytes within fibroblast-macrophage “Niche 5”, expressing MKI67, PCNA, CD68, CD83, linking circulating CM activation to vascular fibroblast proliferation.
-Endothelial subclusters (angiogenic, contractile, homeostatic) further supported remodeling and vascular stiffening in CTEPH lesions.
Cross-Species Integration
-Murine KO models recapitulate human CTEPH pathology: loss of CCR2⁺ CMs impairs thrombus clearance, while loss of NR4A1⁺ NCMs augments fibrosis.
-Human data mirror this imbalance, showing hyperactivated classical monocytes and loss of reparative signatures, together establishing a shared immune–fibrotic program that drives persistent thrombus remodeling.

Conclusion
-Loss of NR4A1⁺ non-classical monocytes removes an antifibrotic brake, allowing CCR2⁺ classical monocytes to dominate and orchestrate fibroblast–endothelial crosstalk—positioning classical monocytes as the key profibrotic effector in CTEPH.
-Hyperactivated classical monocytes (CD14⁺⁺CD16⁻) upregulate profibrotic genes (CTSG, MS4A3, AREG, FOXI2, PDGFRA, THBS2), driving fibroblast proliferation and endothelial remodeling—establishing CMs as the central effectors of fibrosis in CTEPH.
-A dual-target strategy targeting the CCR2⁺ classical monocyte axis and restoring NR4A1-mediated reparative signaling could rebalance immune–fibrotic responses and halt CTEPH progression and promote thrombus resolution.
-Combined inhibition of monocyte recruitment (CCR2) and fibroblast activation represents a rational immune-modulatory approach for future trials.


Monocyte Subset Reprogramming Drives Fibrosis in CTEPH: A Pathway to Immune-Targeted Therapy



Background:
Bioprosthetic valve degeneration, particularly involving the Trifecta surgical aortic valve, has become an increasingly recognized clinical challenge due to its propensity for early structural valve deterioration and failure. Severe aortic regurgitation (AR) resulting from immobile or flail valve leaflets often presents with complex hemodynamic consequences, including functional mitral stenosis—a condition also known as pseudo-mitral stenosis. This phenomenon occurs when the regurgitant aortic jet impinges upon the anterior mitral leaflet, restricting its motion and creating an obstruction to diastolic mitral inflow. Clinically, this manifests as an Austin Flint murmur and may mimic organic mitral valve disease, complicating diagnosis. Distinguishing functional mitral stenosis from intrinsic mitral pathology is critical because the treatment focus should be on correcting the primary aortic valve lesion. Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a less invasive, effective alternative to redo surgical valve replacement in patients with degenerated bioprosthetic valves who are at elevated surgical risk.
Case Presentation:
We report the case of an 84-year-old male with a history of a Trifecta bioprosthetic aortic valve replacement who presented with progressive exertional dyspnea, orthopnea, and acute hypoxic respiratory failure. Initial transthoracic and transesophageal echocardiography revealed severe eccentric AR due to an immobile bioprosthetic leaflet, accompanied by severe functional mitral stenosis characterized by a markedly elevated mean mitral valve gradient of 17 mmHg and reduced mitral valve area, despite structurally normal mitral leaflets. Right and left heart catheterization demonstrated elevated left atrial and pulmonary pressures, consistent with the dual-valve pathology. The patient’s comorbidities—including chronic kidney disease, severe obstructive sleep apnea, prior cerebrovascular accident with residual deficits, and frailty—rendered him high-risk for conventional redo surgery. After multidisciplinary evaluation, the patient underwent a transfemoral ViV-TAVR using a 23 mm Edwards SAPIEN Ultra valve with prophylactic coronary protection. Post-procedure imaging confirmed successful valve deployment with complete resolution of aortic regurgitation and significant reduction in mitral valve gradient to 6 mmHg. Mitral valve mobility and effective valve area improved, demonstrating reversal of functional mitral stenosis.
Discussion:
This case highlights the intricate pathophysiology of functional mitral stenosis secondary to severe AR caused by bioprosthetic valve degeneration. The findings underscore the importance of thorough echocardiographic and hemodynamic evaluation to differentiate pseudo-mitral stenosis from primary mitral valve disease. Correction of the aortic valve pathology alone can restore mitral valve function, obviating the need for direct mitral intervention. ViV-TAVR offers a safe and effective minimally invasive treatment option for high-risk patients with complex dual-valve dysfunction. Comprehensive pre-procedural imaging, including transthoracic and transesophageal echocardiography and computed tomography, is essential for accurate diagnosis and procedural planning, especially to mitigate risks such as coronary obstruction. This case adds to the growing evidence supporting ViV-TAVR in managing complex valvular heart disease and emphasizes the clinical relevance of recognizing the Austin Flint phenomenon in patients with severe aortic insufficiency.



Double Trouble, One Solution: Valve-in-Valve TAVR Corrects Both Aortic and Mitral Valve in a Complex Dual-Valve Pathology

Drug-Induced Liver Injury (DILI) often has delayed identification due to the latency and idiosyncratic nature of the injury. The treatment for DILI is removal of the offending agent and supportive care with consideration that ALT and AST can downtrend quickly whereas Alkaline Phosphatase may increase for months after. 
Our patient is a 22 year old male who presents with 5 days of abdominal pain and diarrhea accompanied by pale stools, dark urine, generalized pruritus, and scleral icterus. His liver enzymes were all elevated, and his R score was 2.2 suggestive of a mixed pattern of both hepatocellular and cholestatic liver injury. Initial workup tested for viral hepatitis, Wilson’s disease, alpha-1 antitrypsin deficiency, and hereditary hemochromatosis. The patient denied any new medications, supplements, or drug use other than natural cannabinoids. An autoimmune liver panel ruled out PBC/PSC, and Stool Studies were unrevealing for acute GI illness. The patient was sexually active with multiple partners, but STI work-up only showed a resolved syphilis infection.
Despite this negative laboratory work up, abdominal ultrasound revealed coarse echogenicity suggestive of hepatic inflammation and MRCP was significant for mild hepatomegaly. Finally, liver biopsy revealed mixed inflammatory infiltrate reflecting a likely drug-induced liver injury. Upon more thorough medical reconciliation, dispense reports from an out-of-city urgent care showed amoxicillin prescribed 2 months prior, and the patient ultimately revealed a history of strep throat treated with a full course of antibiotics which he had forgotten about. 
The patient’s presentation was consistent with this diagnosis but history and labs were originally unrevealing as the injury occurred months prior and symptoms manifested separately. This case demonstrates the importance of obtaining a detailed medication history and inquiring into older infections, as DILI can have a delayed presentation several months after the offending agent is removed and patients often do not recall certain medications until specifically prompted. It also exhibits the relative utility of liver biopsy in diagnosing otherwise vague presentations when noninvasive workup is inconclusive. This patient’s ALT and AST downtrended over time, but his Alkaline Phosphatase continued to increase even months after amoxicillin use. This variability in liver enzyme trends is due to cholestatic injury having a more protracted course because bile duct injury takes months to heal whereas hepatocellular injury can resolve within days.

Diagnostic Challenges of Amoxicillin Induced Liver Injury

Background: Pathogenic variants in SCN2A, a gene encoding the voltage-gated sodium channel (Nav1.2), contribute to a spectrum of epilepsy and neurodevelopmental disorders. The recurrent 16p11.2 duplication is a copy number variant risk loci commonly associated with developmental delays affecting speech and motor functions, with increased seizure risk. 

Case Description: Following a normal pregnancy, neonatal and early developmental period, this female patient was noted to have delayed developmental milestones and failure to thrive at 8 months of age. By 19 months of age, she began experiencing both focal and generalized seizures occurring up to 4 times daily over a 2-month period, ultimately leading to hospitalization. An EEG performed at this time demonstrated epileptiform discharges in the right central, right temporal, and left temporal head regions. Antiepileptic therapies were initiated, with lack of response to phenobarbital and oxcarbazepine, with intolerable side effects to lacosamide. At 20 months of age, regression of skills with worsening language and motor delays and recurrent hand flapping, prompted a titration of previous medications and initiation of clobazam. A brain MRI at this time demonstrated delayed myelination for age without other notable findings. Exam findings at this time included round hypotonic facies, coarse facial features, hypertelorism, arched eyebrows and long eyelashes. 

Results: Seizures persisted and were pharmacoresistant in nature, thus exome sequencing with concurrent chromosomal microarray analysis were initiated at age 20-months. Testing resulted with an interstitial duplication of 565kb of DNA at 16p11.2 (29635211_30199713)x3 and a pathogenic variant in SCN2A c.2557C>T (R853W).
The patient is now 3-years-old and continues to experience focal seizures, reflux, global developmental delay, and self-injurious behavior. A repeat brain MRI revealed progressive volume loss within the supratentorial brain. 

Discussion: This is the first reported case of patient with co-occurring16p11.2 duplication and a heterozygous SCN2A pathogenic variant. It is suspected that much of this patient’s phenotype is caused by the SCN2A variant. As a neurodevelopmental risk loci, the 16p11.2 duplication may increase this patient’s risk for more severe developmental delays, autism, or additional seizures types. Seizure control and early intervention therapies continue to be the mainstays of intervention to improve developmental outcomes, as to date there are no targeted anti-epileptic medications or other precision therapies for SCN2A-DEE.


First Reported Case of Concurrent 16p11.2 Duplication and SCN2A R853W Variant in a Patient with Pharmacoresistant Epilepsy and Developmental Delay

Cocaine and ethanol co-use, the most prevalent polysubstance disorder, occurs in 74% of users. Ethanol potentiates cocaine’s sympathomimetic effects through cocaethylene, a metabolite with a half-life 2-3 times longer. The resulting combination amplifies excitotoxicity, oxidative stress, and neuroinflammation, compounding cerebrovascular risk, including ischemic and hemorrhagic strokes or transient ischemic attacks (TIAs). Cocaine-induced vasospasm, endothelial dysfunction, and hypertensive fluctuations may also provoke temporary neurological deficits, including visual field disturbances. Homonymous hemianopia, typically caused by post-chiasmal pathology (e.g., stroke, intracranial hemorrhage, or mass effect), is conventionally considered irreversible, though exceedingly rare cases of recovery have been reported.

Herein, a 65-year-old male with alcohol use disorder, type II diabetes, hypertension, hyperlipidemia, and hypothyroidism presented for an inpatient detoxification after escalating to 24 beers daily for two weeks, with intermittent cocaine use. He appeared disheveled, depressed and displayed psychomotor retardation but had no tremors or previous seizures. Laboratory studies revealed macrocytic anemia, mild transaminitis, and an ammonia level of 51 μmol/L, with negative toxicology for other substances. Two days post-admission, he developed severe cognitive impairment (MMSE 13/30), inconsistent with alcohol withdrawal given the absence of autonomic instability or hallucinations. A clock drawing test (CDT) revealed right-sided number crowding. Non-contrast CT ruled out acute intracranial pathology but showed chronic ischemic changes. By day four, cognition improved (MMSE 24/30), and CDT normalized.

This case presents a rare, reversible homonymous visual disturbance likely related to cocaine and ethanol-induced cerebral vasospasm in the setting of preexisting cerebrovascular disease. Although the precise mechanism remains unclear, transient visual deficits in polysubstance users may reflect TIAs triggered by drug-induced vasospasm, particularly in patients with underlying small vessel disease. Similar visual disturbances were reported by Burggraaf-Sánchez de las Matas et al., who described a 36-year-old man presenting with bilateral peripapillary hemorrhages and profound vision loss due to alcohol and cocaine use. Toxic-ischemic optic neuropathy hemorrhages resolved within three weeks, and visual acuity (20/20 OU) recovered fully; however, central scotomas persisted, indicating only partial reversibility. Altogether, these cases suggest that combined toxic and vascular insults can result in acute but variably reversible visual sequelae. Future studies may explore advanced neuroimaging correlates, the role of vascular imaging in polysubstance users with transient deficits, and the utility of early cognitive screening tools such as the CDT in detecting subtle visual field changes.


Transient Homonymous Hemianopia in Cocaine and Ethanol Co-Use: A Case of Vasospam-Induced Transient Ischemic Attack

Background: Despite progress in Zambia’s HIV response, the disease still poses a significant health burden on the country. In 2021, Zambia had the 7th highest adult HIV prevalence worldwide at 10.8%, with over 15,000 new infections occurring among youth aged 15-24. The progression of HIV to AIDS has devastating consequences, especially among young people. Between 2005 and 2015, there was a 45% increase in AIDS-related deaths among youth aged 15-19, and AIDS ranks as the second leading cause of death among young women in Africa. Anti-retroviral therapy (ART) is an effective treatment that suppresses HIV viral load by interfering with the viral replication cycle; however, youth living with HIV (YLHIV) in Zambia face significant barriers to antiretroviral therapy (ART) adherence, including stigma and substance use. In 2019, an estimated 65,000 adolescents in Zambia were living with HIV, with only about 60% on ART. Furthermore, 46% of YLHIV in Zambia reported missing a recent clinic appointment. This care deficit leaves most YLHIV virally non-suppressed, making them vulnerable to opportunistic infections and life-threatening complications.

Methods: This study utilized qualitative analysis of focus group discussions (FGDs) among YLHIV (ages 18–24) receiving care at Kanyama First Level Hospital (KFLH) and Matero Urban Health Centre (MUHC) in Lusaka, Zambia. FGDs assessed participants’ experiences of ART adherence, substance use, and HIV self-management. There were six FGDs conducted, three among female participants and three among males. Participants were eligible based on <80% medication adherence in the previous month, combined with substance use during the same period.

Results: FGDs revealed stigma and substance use as major barriers to ART adherence among YLHIV. Participants faced stigma from healthcare providers, family, and friends. Fear of disclosure led adolescents to hide their status, avoid taking medication in public, or disengage from care. Additionally, substance use with alcohol, cannabis, and amphetamines was found to worsen mental health and disrupt medication routines, leading to increased viral replication. 

Conclusion: Non-adherence to ART can be attributed to several intersectional factors, most notably stigma and substance use. To address these barriers, the next phase of the project will utilize FGD findings to design a culturally sensitive mobile health (mHealth) motivational text messaging (MTM) intervention. The intervention aims to improve ART adherence and health outcomes while reducing stigma, addressing substance use, and protecting privacy. Participants will receive motivational text messages reminding them to take their medications, attend clinic appointments, and reduce their substance use.

Stigma and Substance Use as Barriers to ART Adherence Among
Youth Living with HIV in Zambia

Assessing the Perceptions of Osteopathic Medical Students’ beliefs since Transitions in the USMLE step 1 and COMLEX level 1 examinations to Pass/Fail
Student Author: Milo Taylor
Mentor: Robert Goldsteen
Objective: since the transition of the USMLE step 1 and COMLEX level 1 examinations to pass/fail in 2022, there has been very little research into the impact of this transition on osteopathic medical students. The goal of this study is to investigate the impact of the transitions of these exams to pass/fail on osteopathic student well-being depending on their intended specialty. 
Methods: A Qualtrics survey was administered to students at the Burrell College of Osteopathic Medicine. This survey included a free response question asking what specialty the student intended to pursue. Then the perceived stress scale 10 (PSS-10) was administered. The responses were divided into four groups based on how competitive the intended specialty was. The PSS-10 score averages were calculated for each group and compared. 
Results: the most competitive group had a PSS-10 mean score of 20.29, the intermediate group had a mean PSS-10 score of 21.29, the least competitive group had a mean PSS-10 score of 21, and the undecided group had a mean PSS-10 score of 20.33. 
Conclusion: There was very little difference in stress levels between the four groups, and therefore intended specialty seemed to not have any effect on stress levels. This possibly confirms our hypothesis that there would be no difference in stress levels between the groups because the pressure of obtaining a high numerical score on these exams has been eliminated. While this preliminary data suggests that the NBOME and NBME may have succeeded in improving student well-being with the decision to make these exams pass/fail, further research must be done to investigate the effects of this transition. 




Next from 2025 AMA Research Challenge – Member Premier Access

Low-Dose Colchicine as an NSAID Alternative in Orthopedic Patients: A Retrospective Review