A Randomized Controlled Trial To Determine Whether Beta-Hydroxy-Beta-Methylbutyrate And/Or Eicosapentaenoic Acid Improves Diaphragm And Quadriceps Strength In Critically Ill Mechanically Ventilated Patients, 2021 University of Kentucky
A Randomized Controlled Trial To Determine Whether Beta-Hydroxy-Beta-Methylbutyrate And/Or Eicosapentaenoic Acid Improves Diaphragm And Quadriceps Strength In Critically Ill Mechanically Ventilated Patients, Gerald S. Supinski, Paul F. Netzel, Philip M. Westgate, Elizabeth A. Schroder, Lin Wang, Leigh Ann Callahan
Internal Medicine Faculty Publications
BACKGROUND: Intensive care unit acquired weakness is a serious problem, contributing to respiratory failure and reductions in ambulation. Currently, there is no pharmacological therapy for this condition. Studies indicate, however, that both beta-hydroxy-beta-methylbutyrate (HMB) and eicosapentaenoic acid (EPA) increase muscle function in patients with cancer and in older adults. The purpose of this study was to determine whether HMB and/or EPA administration would increase diaphragm and quadriceps strength in mechanically ventilated patients.
METHODS: Studies were performed on 83 mechanically ventilated patients who were recruited from the Medical Intensive Care Units at the University of Kentucky. Diaphragm strength was assessed ...
Factors Motivating Smoking Cessation: A Cross-Sectional Study In A Lower-Middle-Income Country, 2021 Aga Khan University
Factors Motivating Smoking Cessation: A Cross-Sectional Study In A Lower-Middle-Income Country, Russell Seth Martins, Muhammad Umer Junaid, Muhammad Sharjeel Khan, Namrah Aziz, Zoha Zahid Fazal, Mariam Umoodi, Fatima Shah, Javaid Ahmed Khan
Medical College Documents
Introduction: Only one-quarter of smokers in Pakistan attempt to quit smoking, and less than 3% are successful. In the absence of any literature from the country, this study aimed to explore factors motivating and strategies employed in successful smoking cessation attempts in Pakistan, a lower-middle-income country.
Methods: A survey was carried out in Karachi, Pakistan, amongst adult (≥ 18 years) former smokers (individuals who had smoked ≥100 cigarettes in their lifetime but who had successfully quit smoking for > 1 month at the time of survey). Multivariable logistic regression, with number of quit attempts (single vs. multiple) as the dependent variable, was ...
A Case Report: Utilization Of Topical Amphotericin In Postoperative Mucormycosis, 2021 Regional Medical Center Bayonet Point
A Case Report: Utilization Of Topical Amphotericin In Postoperative Mucormycosis, Kenny Wang, Jomel Jacinto, Alex Davis, Andrei Hetman, Alok Kumar
HCA Healthcare Journal of Medicine
Mucormycosis is a rare devastating fungal infection with a high mortality rate often associated with diabetic and immunosuppressed individuals. However, infections found in postoperative states and in immunocompetent patients are rare. Systemic liposomal amphotericin is viewed as a first line treatment for mucormycosis in addition to aggressive debridement to prevent the spread of infection. Literature describing the treatment of mucormycosis with both systemic and topical amphotericin B is scarce. We present a case of an immunocompetent male admitted for perforated diverticulitis who received a left hemicolectomy with colostomy creation. During hospitalization, stool from the colostomy bag was reportedly leaking into ...
A Rare Presentation Of Bilateral Bochdaleck Congenital Diaphragmatic Hernia, A Case Study, 2021 Oak Hill Hospital
A Rare Presentation Of Bilateral Bochdaleck Congenital Diaphragmatic Hernia, A Case Study, Manuel Britto, Sean Michael, Sofia I. Cartaya, Bernard Alfredo Cartaya
HCA Healthcare Journal of Medicine
Congential diaphragmatic hernias (CDH) are a rare process that have a prevalence of 1–4 cases per 10,000 live births, and of these, bilateral Bochdalek congenital diaphragmatic hernias are even rarer entities that occur in about 1% of cases. This finding is rarely documented in literature. This paper offers a detailed methodical timeline documentation of the events that occurred after delivery and includes how to approach the diagnosis and management of such a rare and volatile condition.
The neonate was born at 35 weeks and 6 days gestation. Unfortunately, despite intensive cardiopulmonary resuscitation efforts, the neonate expired ...
Is Microthrombosis The Main Pathology In Coronavirus Disease 2019 Severity?-A Systematic Review Of The Postmortem Pathologic Findings, Omar H. Fahmy, Farah M. Daas, Vidyulata Salunkhe, Jessica L. Petrey, Ediz F. Cosar, Julio Ramirez, Ozan Akca
COVID-19 Publications by UMMS Authors
This systematic review attempts to retrieve and report the findings of postmortem studies including the histopathologic data of deceased coronavirus disease 2019 patients and to review the manifestations of coronavirus disease 2019-associated thrombotic pathologies reported in the recent literature.
Data Sources: PubMed, Excerpta Medica Database, and Cochrane library between December 1, 2019, and August 26, 2020.
Study Selection: Investigators screened 360 unique references, retrieved published autopsy series, and report on the postmortem histopathologic information on patients who had died of coronavirus disease 2019.
Data Extraction: Investigators independently abstracted all available data including study design, participant demographics, key histopathologic findings, disease ...
A New Paradigm: Ecmo Therapy In Pediatric Hematology/Oncology Patients, 2021 Children's Mercy Kansas City
A New Paradigm: Ecmo Therapy In Pediatric Hematology/Oncology Patients, Igor Areinamo
Background: The use of extracorporeal membrane oxygenation (ECMO) for support of pediatric patients has significantly increased in the past years. Patients with known oncologic diseases, immunodeficiencies, or bone marrow transplants (BMT) have traditionally not been considered candidates for Extracorporeal membrane oxygenation (ECMO) due to perceived high risk for mortality. Ongoing advances have continued to push the boundaries of ECMO use and we report our recent experience with this patient population
Objectives/Goal: To evaluate survival to discharge of pediatric patients who require ECMO support and who also have an underlying hematologic or oncologic disease process. To determine specific patient characteristics ...
Multimodal Pain Control In Common Neonatal Surgeries: Post-Operative Pain Protocol Reduces Opiate Exposure And Side Effects, 2021 Children's Mercy Hospital
Multimodal Pain Control In Common Neonatal Surgeries: Post-Operative Pain Protocol Reduces Opiate Exposure And Side Effects, Jamesia Donato
Background: Opioids are the primary post-operative (post-op) analgesic in neonates. Side effects include hypotension, apnea and ileus. Previous studies show IV acetaminophen decreases opiate need in specific populations including cleft palate repair, cardiac surgery. The effect of IV acetaminophen as part of a post-op pain algorithm is not known in common neonatal surgical procedures.
Objectives/Goal: To determine if (a) a post-op pain algorithm including IV acetaminophen and (b) IV acetaminophen exposure reduces cumulative opioid requirements in neonates undergoing common surgeries in the NICU.
Methods/Design: This is a retrospective cohort study comparing cumulative post-operative opiate exposure between infants with ...
Pediatric Pulmonary Artery Aneurysms Causing Pulmonary Hemorrhage: A Case Of Transcatheter Intervention While On Va Ecmo Support, 2021 Children's Mercy Kansas City
Pediatric Pulmonary Artery Aneurysms Causing Pulmonary Hemorrhage: A Case Of Transcatheter Intervention While On Va Ecmo Support, Igor Areinamo
Background: The incidence of pulmonary artery aneurysm (PAA) in children remains unknown. There are few reports of a transcutaneous interventional approach to address this type of pathology. Management of PAAs while on VA ECMO has not been described in pediatrics.
Case: 9-year-old previously healthy male presented with MRSA associated ARDS and sepsis requiring urgent VA ECMO cannulation. Chest CT done on ECMO day 22 showed development of right sided PAAs. Patient had an episode of significant pulmonary hemorrhage. Angiogram demonstrated two fusiform right PAAs, one of which had ruptured and was bleeding into the lung parenchyma ...
Role Of Interferon Gamma Release Assay In The Diagnosis And Management Of Mycobacterium Tuberculosis-Associated Uveitis: A Review, 2021 Karachi Medical and Dental College, Karachi, Pakistan
Role Of Interferon Gamma Release Assay In The Diagnosis And Management Of Mycobacterium Tuberculosis-Associated Uveitis: A Review, Samra Rahman, Muhammad Irfan, Rehman Siddiqui
Section of Pulmonary & Critical Care
Tuberculosis (TB)-associated uveitis is a common cause of infectious uveitis in the developing world. Diagnosis of TB uveitis remains a challenge. The role of interferon gamma release assays (IGRAs) is uncertain. Herein we summarise the available literature on the utility of IGRAs in the diagnosis and management of TB uveitis. We searched PubMed database from 1 August 2010 to 31 July 2020 using the following keywords alone and in combination: 'interferon-gamma release assay', 'QuantiFERON', 'T-SPOT.TB', 'TB uveitis', 'serpiginous like choroiditis', 'tuberculoma', 'TB vasculitis', 'TB panuveitis' and 'ocular tuberculosis'. Data from 58 relevant studies were collated. The review is ...
Local Implementation And Standardization Of The Pediatric Severe Traumatic Brain Injury Guidelines, 2021 Children's Mercy Kansas City
Local Implementation And Standardization Of The Pediatric Severe Traumatic Brain Injury Guidelines, Michelle Brown
Problem Statement/Question: Severe pediatric Traumatic Brain Injury (TBI) remains a significant cause of morbidity and mortality. Evidence-based guidelines leave gaps in how to best implement and deliver standardized care on the local hospital level.
Background/Project Intent (Aim Statement): We aim to improve clinical outcomes for severe TBI patients (Glasgow Coma Scale ≤8) with standardization of care according to updated evidence-based guidelines. We will target early guideline adherence (initial 72 hours of PICU admission) with a focus on 1) targeted temperature management (TTM40mmHg).
Methods (include PDSA cycles): The Children’s Mercy Hospital Pediatric ICU Severe TBI Guidelines were updated ...
C-Reactive Protein Values To Predict Sepsis-Induced Inflammatory Response In Premature Infants, 2021 Children's Mercy Kansas City
C-Reactive Protein Values To Predict Sepsis-Induced Inflammatory Response In Premature Infants, Megan H. Tucker
Background: C-reactive protein (CRP) is an inflammatory marker that has been recognized as a biomarker of the systemic inflammatory response in preterm neonates. We hypothesized that initial and peak CRP values would correlate with the degree of sepsis-induced acute lung injury (ALI) as measured by the pulmonary severity score (PSS).
Objectives/Goal: 1) Determine if confirmed (CF) sepsis events are associated with higher initial and peak CRP values than rule out (RO) sepsis events. 2) Investigate if initial and/or peak CRP correlates with severity of sepsis-induced ALI as measured by the PSS.
Methods/Design: In this retrospective case control ...
Educating Providers: Timely Post-Operative Pain Management In A Level Iv Neonatal Intensive Care Unit (Nicu), 2021 Children's Mercy Hospital
Educating Providers: Timely Post-Operative Pain Management In A Level Iv Neonatal Intensive Care Unit (Nicu), Jamesia Donato, Jamesia Donato
Background/Project Intent (Aim Statement): NICU patients often encounter painful procedures and can have significant short and long-term consequences from inadequately treated pain. Ensuring adequate pharmacological and nonpharmacological pain management while minimizing associated risks is paramount. Our NICU is part of the Children’s Hospitals Neonatal Consortium “Erase Pain” collaborative to improve management of postop pain in neonates. SMART Aim: Increase the percentage of patients receiving acetaminophen within one hour after surgery to greater than 70% by July 2020.
Methods (include PDSA cycles): A multidisciplinary team developed pain treatment algorithms and postop order plans to standardize the approach to postop ...
Pulmonary Severity Score As A Measure Of Sepsis-Induced Acute Lung Injury In Preterm Infants, 2021 Children's Mercy Kansas City
Pulmonary Severity Score As A Measure Of Sepsis-Induced Acute Lung Injury In Preterm Infants, Megan H. Tucker
Background: Sepsis is the most common indirect cause of acute lung injury (ALI) in adult and pediatric patients, yet no studies have described this phenomenon in preterm infants. We hypothesize that sepsis-induced ALI occurs in neonates and increases the risk of bronchopulmonary dysplasia (BPD) in preterm infants.
Objectives/Goal: 1) To investigate whether late onset sepsis (LOS) and other systemic inflammatory diseases are temporally correlated with ALI as quantified by pulmonary severity score (PSS) trajectory. 2) To determine the sepsis subtypes associated with the greatest severity of ALI.
Methods/Design: We included infants < 31 weeks gestational age and < 1500 grams with LOS in this retrospective case control study. The PSS was calculated at 72, 48, and 24 hours (hr) prior to, at the time of, and 24, 48, 72, and 168hr after sepsis diagnosis. We further defined rule out (RO) sepsis (blood culture negative; antibiotics continued only 48-72hr), blood culture positive (Cx+) sepsis, necrotizing enterocolitis (NEC), urinary tract infection (UTI), and culture negative (Cx-) clinical sepsis (blood culture negative; antibiotics continued > 6 days; specific lab criteria met). PSS ...
Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, 2021 Children's Mercy Hospital
Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, Gina Patel, Jenna Miller, Thomas M. Attard, Asdis Finnsdottir Wagner
Incidence and management of Gastrointestinal (GI) bleeding on ECMO isn’t well reported Patients on ECMO require systemic anticoagulation making GI bleeding difficult to manage We describe the use of enteral tranexamic acid (TXA) in two pediatric patients with GI hemorrhage on ECMO
Evaluation Of An Elevated Vte Thromboprophylaxis Guideline For Critically Ill Patients Infected With Covid-19, 2021 Baptist Hospital of Miami
Evaluation Of An Elevated Vte Thromboprophylaxis Guideline For Critically Ill Patients Infected With Covid-19, Tony Nguyen, Heidi Clarke
Retrospective studies and systematic-review meta-analysis have shown an association in inducing a prothrombotic state in patients infected with COVID-19. The risk of VTE are compounded in the critically ill. Current practices at Baptist Hospital of Miami (BHM) is to routinely order standard prophylactic dosed chemical thromboprophylaxis for all patients infected with COVID-19. In August 2020 an anticoagulation guidance document was approved to tailor anticoagulation dosing for critically ill COVID-19 patients. At risk patients were based on clinical and laboratory markers such as D-dimer, CRP, and ferritin. Following implementation, our analysis show a statistically significant reduction in the number of treatment ...
Recalibration Of The Renal Angina Index For Pediatric Septic Shock., 2021 Children's Mercy Hospital
Recalibration Of The Renal Angina Index For Pediatric Septic Shock., Natalja L. Stanski, Hector R. Wong, Rajit K. Basu, Natalie Z. Cvijanovich, Julie C. Fitzgerald, Scott L. Weiss, Michael T. Bigham, Parag N. Jain, Adam Schwarz, Riad Lutfi, Jeffrey Nowak, Geoffrey L. Allen, Neal J. Thomas, Jocelyn R. Grunwell, Michael Quasney, Bereketeab Haileselassie, Lakhmir S. Chawla, Stuart L. Goldstein
Manuscripts, Articles, Book Chapters and Other Papers
Introduction: Sepsis-associated acute kidney injury (AKI) is a common diagnosis in children that is associated with poor outcomes. The lack of therapeutic options once present makes early identification of at-risk patients essential. The renal angina index (RAI) has been previously validated to predict severe AKI in heterogeneous populations of critically ill children. The performance of this score specifically in children with septic shock is unknown.
Methods: A secondary analysis of a multicenter, prospective, observational study of 379 children with septic shock to determine the ability of the RAI to predict severe AKI at day 3, and to assess for the ...
Efficacy Of Advanced Prehospital Communication In Acute Ischemic Stroke Treatment, 2021 University of Texas at Tyler
Efficacy Of Advanced Prehospital Communication In Acute Ischemic Stroke Treatment, Dylan Horinek
MSN Capstone Projects
Ischemic stroke outcomes are directly affected by time to treatment. This intervention demonstrates promise in decreasing time to treatment by optimizing pres-hospital communication, basically giving a report to providers and registration information before the patient arrives at the facility. The use of an advanced digital application has demonstrated in multiple studies significant difference in time to treatment in ischemic stroke, and ultimately leads to improved patient outcomes, increased staff satisfaction, and increased facility revenue.
Violence Against Healthcare Workers During The Covid-19 Pandemic: A Review Of Incidents From A Lower-Middle-Income Country, Omaima Anis Bhatti, Hareem Rauf, Namrah Aziz, Russell Seth Martins, Javaid Ahmed Khan
Medical College Documents
Background: Healthcare workers (HCWs) across the globe have met tremendous challenges during the COVID-19 (coronavirus disease 2019) pandemic, such as shortages of personal protective equipment, extensive work hours, and constant fear of catching the virus or transmitting it to loved ones. Adding on to the already existing burnout, an increase in incidents of violence and aggression against HCWs was seen in Pakistan and globally.
Objectives: Primarily to review cases of violence against HCWs in Pakistan, highlighting and comparing the instigating factors seen within the country and globally. Secondly, to enlist possible interventions to counter workplace violence in healthcare during a ...
Respiratory Pathogens In Patients With Acute Exacerbation Of Non-Cystic Fibrosis Bronchiectasis From A Developing Country, Shayan Shahid, Kausar Jabeen, Nousheen Iqbal, Joveria Farooqi, Muhammad Irfan
Medical College Documents
Bronchiectasis unrelated to cystic fibrosis (non-CF bronchiectasis) has become a major respiratory disease in developing nations. The dilated mucus filled airways promote bacterial overgrowth followed by chronic infection, bronchial inflammation, lung injury and re-infection Accurate pathogen identification and antimicrobial susceptibility allowing appropriate treatment, in turn, may break this vicious cycle. To study the spectrum and antimicrobial spectrum of pathogen yielded from respiratory specimens in adult patients with acute exacerbation of non-cystic fibrosis (CF) bronchiectasis. This cross-sectional study was performed at the pulmonology clinics of the Aga Khan University, Karachi, Pakistan from 2016-2019. Respiratory specimens were collected from adult patients with ...
C25: The “Spot Sign”: A Predictor Of Hematoma Expansion, 2021 Roseman University of Health Sciences
C25: The “Spot Sign”: A Predictor Of Hematoma Expansion, Mckenzie Merritt
Annual Research Symposium
No abstract provided.