Major Thrombotic Event Despite Anticoagulation In A Patient With Covid-19., 2020 Northwell Health
Major Thrombotic Event Despite Anticoagulation In A Patient With Covid-19., B. Ataallah, A. Sharma, S. Tamanna, J. Ng, G. Haggerty
Journal Articles
The outbreak of coronavirus disease 2019 (known as COVID-19), which started in Wuhan, China in December 2019, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been associated with both venous and arterial thromboembolism likely secondary to significant cytokine activation and inflammation. Reports on the incidence of thrombotic complications, however, are not well documented. Our case will examine a young man diagnosed with COVID-19 who developed an acute, severe bilateral saddle pulmonary embolism while on prophylactic dose anticoagulation after being admitted to the hospital and treated for two weeks with significant improvement.
Pulmonary Embolism In Patients Hospitalized With Covid-19 (From A New York Health System), 2020 Zucker School of Medicine at Hofstra/Northwell
Pulmonary Embolism In Patients Hospitalized With Covid-19 (From A New York Health System), H. Xu, A. Martin, A. Singh, M. Narasimhan, J. Lau, M. Weinberg, R. Jauhar, G. Rao
Journal Articles
© 2020 Elsevier Inc. Pulmonary embolisms (PEs) in coronavirus disease 2019 (COVID-19) have increasingly been reported in observational studies. However, limited information describing their clinical characteristics and outcomes exists. Our study aims to describe clinical features and risk stratification strategies of hospitalized COVID-19 patients with PE. We retrospectively analyzed 101 hospitalized patients with COVID-19 infection and acute PE. Clinical outcomes measured were intensive care unit admission, mechanical ventilation, bleeding and transfusion events, acute kidney injury (AKI) and mortality. Pulmonary severity index (PESI) scores were used for risk stratification. The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) …
Seizure And Covid-19: Association And Review Of Potential Mechanism., 2020 Northwell Health
Seizure And Covid-19: Association And Review Of Potential Mechanism., R. Joseph, N. Narula, A. Daouk, N. Katyal, S. Acharya, A. Avula, R. Maroun
Journal Articles
Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, this highly transmissible virus has since spread rapidly around the world. Though respiratory complication is the primarily reported manifestation though rare, yet serious neurological complications are being frequently reported in the literature. In selected coronavirus disease-2019 (COVID-19) cases neurologic complications may manifest as seizures. In this paper, we have reviewed current literature on seizures linked with SARS- COV 2 infection including published or pre-print original articles, review articles, and case reports. We have discussed the electroencephalogram (EEG), imaging, and Cerebrospinal fluid (CSF) findings in COVID-19 patients …
Study Of Alteplase For Respiratory Failure In Sars-Cov2/Covid-19: Study Design Of The Phase Iia Stars Trial., 2020 Zucker School of Medicine at Hofstra/Northwell
Study Of Alteplase For Respiratory Failure In Sars-Cov2/Covid-19: Study Design Of The Phase Iia Stars Trial., H. B. Moore, C. D. Barrett, E. E. Moore, R. Jhunjhnuwala, R. C. Mcintyre, P. K. Moore, J. Wang, N. Hajizadeh, A. Sauaia, M. B. Yaffe, +1 Additional Author
Journal Articles
Background:The COVID-19 pandemic has caused a large surge of acute respiratory distress syndrome (ARDS). Prior phase I trials (non COVID-19) demonstrated improvement in pulmonary function in ARDS patients using fibrinolytic therapy. A follow-up trial using the widely available tissue-plasminogen activator (alteplase) is now needed to assess optimal dosing and safety in this critically ill patient population. Objective:To describe the design and rationale of a Phase IIa trial to evaluate the safety and efficacy of alteplase treatment for moderate/severe COVID-19-induced ARDS. Patients/Methods:A rapidly adaptive, pragmatic, open label, randomized, controlled, phase IIa clinical trial will be conducted with three groups: intravenous(IV) alteplase …
Repurposing Orthopaedic Residents Amid Covid-19: Critical Care Prone Positioning Team., 2020 Northwell Health
Repurposing Orthopaedic Residents Amid Covid-19: Critical Care Prone Positioning Team., O. F. Rahman, D. P. Murray, R. M. Zbeda, A. D. Volpi, A. Z. Mo, N. A. Wessling, B. A. Mina, M. S. Mendez-Zfass, C. Carpati
Journal Articles
No abstract provided.
Cytokine Storm Of A Different Flavor: The Different Cytokine Signature Of Sars-Cov2 The Cause Of Covid-19 From The Original Sars Outbreak., 2020 Northwell Health
Cytokine Storm Of A Different Flavor: The Different Cytokine Signature Of Sars-Cov2 The Cause Of Covid-19 From The Original Sars Outbreak., D. O. Griffin, A. Jensen, M. Khan, J. Chin, K. Chin, J. Saad, R. Parnell, C. Awwad, D. Patel
Journal Articles
We present a case series of three patients with COVID-19 who had a cytokine panel which revealed elevation of interleukin-6 (IL-6), but normal levels of interleukin-10 (IL-10), interferon-gamma (INF-γ) and interleukin-8 (IL-8) in contrast to the cytokine signature described in Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS). We also documented evidence of a compromised T-cell IFN-gamma response in two of these patients.
Association Of Anticoagulation Dose And Survival In Hospitalized Covid-19 Patients: A Retrospective Propensity Score-Weighted Analysis, 2020 Zucker School of Medicine at Hofstra/Northwell
Association Of Anticoagulation Dose And Survival In Hospitalized Covid-19 Patients: A Retrospective Propensity Score-Weighted Analysis, F. Ionescu, I. Jaiyesimi, I. Petrescu, P. R. Lawler, E. Castillo, Y. Munoz-Maldonado, Z. Imam, M. Narasimhan, A. E. Abbas, G. B. Nair, +1 Additional Author
Journal Articles
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Background: Hypercoagulability may contribute to COVID-19 pathogenicity. The role of anticoagulation (AC) at therapeutic (tAC) or prophylactic doses (pAC) is unclear. Objectives: We evaluated the impact on survival of different AC doses in COVID-19 patients. Methods: Retrospective, multi-center cohort study of consecutive COVID-19 patients hospitalized between March 13 and May 5, 2020. Results: A total of 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n = 642) required intensive care unit (ICU) stay. 60.9% received pAC (n …
Recommendations For Core Critical Care Ultrasound Competencies As A Part Of Specialist Training In Multidisciplinary Intensive Care: A Framework Proposed By The European Society Of Intensive Care Medicine (Esicm), 2020 Zucker School of Medicine at Hofstra/Northwell
Recommendations For Core Critical Care Ultrasound Competencies As A Part Of Specialist Training In Multidisciplinary Intensive Care: A Framework Proposed By The European Society Of Intensive Care Medicine (Esicm), A. Wong, L. Galarza, L. Forni, D. De Backer, M. Slama, B. Cholley, P. Mayo, A. Mclean, F. Duška, +17 Additional Authors
Journal Articles
© 2020 The Author(s). Critical care ultrasound (CCUS) is an essential component of intensive care practice. Although existing international guidelines have focused on training principles and determining competency in CCUS, few countries have managed to operationalize this guidance into an accessible, well-structured programme for clinicians training in multidisciplinary intensive care. We seek to update and reaffirm appropriate CCUS scope so that it may be integrated into the international Competency-based Training in Intensive Care Medicine. The resulting recommendations offer the most contemporary and evolved set of core CCUS competencies for an intensive care clinician yet described. Importantly, we discuss the rationale …
Characteristics And Outcomes Of Patients Directly Discharged To Home From The Intensive Care Unit, 2020 Thomas Jefferson University
Characteristics And Outcomes Of Patients Directly Discharged To Home From The Intensive Care Unit, Ann Zheng, Preeyal M. Patel, Michele Fiorella, Lauren Mcdonnell, Mina Yasuoka, Erika J. Yoo, Md
Phase 1
Introduction: Given the current era of decreasing hospital bed availability, there has been a rise in the practice of direct discharge to home (DDH) from ICUs. We evaluated the demographics, clinical characteristics, outcomes and readmission patterns among DDH patients.
Methods: Retrospective review of patients from 2 MICUs from June 2017 to June 2019 at Thomas Jefferson University hospital, an urban tertiary care center. Primary outcome of interest was 30-day hospital readmission. Patients were dichotomized into two groups based on time between ward transfer order and hospital discharge (<24 or ≥24 hours). Risk adjustment performed with Mortality Probability Model (MPM0 -III). ICU workload at admission and discharge was estimated with nine equivalents of nursing manpower use score (NEMS). Patient characteristics compared using t-test and Fisher exact or χ2 test.
Results: 331 DDH patients were analyzed, with the majority …
Investigation Of Molecular Mechanisms Of Liver Preservation Injury: A Complication Preceding Organ Transplantation, 2020 Virginia Commonwealth University
Investigation Of Molecular Mechanisms Of Liver Preservation Injury: A Complication Preceding Organ Transplantation, Ria C. Fyffe-Freil
Theses and Dissertations
Of the over 108,000 American awaiting a life-saving organ transplant today, over 12,000 (11%) of those need a new liver (OPTN, 2020). Last year, only 35% of patients on the waiting list for an organ were transplanted. Improving the quality of marginal organs by preventing or reversing preservation injury could vastly increase the number of transplants performed. Washout of circulating blood during liver procurement with cold University of Wisconsin solution flushes out any endogenous pro-survival signaling molecules. We investigated lysophospholipid (LPL) surface receptors (G-protein coupled receptors for lysophosphatidic acid (LPA) and sphingosine- 1-phosphate (S1P)) and their role in protecting hepatocytes …
Global Health Immersive Elective In The Philippines, 2020 Children's Mercy Hospital
Global Health Immersive Elective In The Philippines, Lisa Godfrey
Posters
Describes her experiences working at Fabella Memorial NICU and the Philippines General Hospital.
Philippines: An Int-Erupted Experience, 2020 Children's Mercy Hospital
Philippines: An Int-Erupted Experience, Susamita Kesh
Posters
Describes her experience working in the NICU of the Fabella Memorial Hospital in Philippines.
Nurse Driven Enteral Nutrition Protocol For Mechanically Ventilated Patients, 2020 University of Kentucky
Nurse Driven Enteral Nutrition Protocol For Mechanically Ventilated Patients, Deena Shewekah
DNP Projects
Introduction: Delayed enteral nutrition in critically ill patients increases the risk of complications and poor outcomes. Current evidence-based guidelines recommend initiation of enteral nutrition within 24-48 hours of intensive care unit (ICU) admission. The quality improvement (QI) project aim was to examine whether enteral nutrition was initiated within 24- 48 hours of mechanical ventilation after implementation of QI intervention in order to determine practice change.
Methods: The QI protocol was introduced to the Cardiovascular ICU (CVICU) at UK Chandler Hospital (UKHC) nurses via an education session. A post-education electronic survey identified the nurse’s understanding of the protocol. To identify nursing …
A Reevaluation Of The Importance Of Timing To Antibiotic Administration In Patients With Sepsis And Septic Shock In The Emergency Department, 2020 Arcadia University
A Reevaluation Of The Importance Of Timing To Antibiotic Administration In Patients With Sepsis And Septic Shock In The Emergency Department, Melissa Yoon
Capstone Showcase
Sepsis is a life threatening organ dysfunction that is caused by the body’s dysregulated response to an infection. A crucial component of treatment includes intravenous antibiotic administration and is recommended within 1 hour of suspected sepsis. However, research conducted over the past two decades have produced mixed results regarding the relationship between mortality rates and this 1 hour time limit. In light of issues such as increasing antibiotic resistance and limited resources in emergency departments, this study reviewed current literature to critically evaluate the effects of modest delays in antibiotic administration in sepsis and septic shock. The studies suggest that …
Corpus Cavernosum Abscess Secondary To Traumatic Perforation Of Urethral Diverticulum, 2020 HCA Healthcare
Corpus Cavernosum Abscess Secondary To Traumatic Perforation Of Urethral Diverticulum, Thomas C. Gore, Anna Schepcoff, Domenick Sorresso
West Florida Division Virtual Research Day 2020
A corpus cavernosum abscess is a rare condition. Usual etiologies include penile injection of erectile dysfunction medications or illicit drugs, priapism, sexually transmitted infections, and trauma; however, there have been reported cases of idiopathic etiology. The most common causative organisms include Staphylococcus aureus, Streptococci, and Bacteroides [1]. Diagnosis is typically made clinically and through imaging (computed tomography [CT] and ultrasound). The first-line treatment is the use of intravenous (IV) antibiotics and surgical drainage. More conservative treatment, however, includes aspiration in conjunction with IV antibiotics [2-3]. Urethral diverticulum (UD) is the formation of a saccular outpouching of the urethral lumen. Symptoms …
An Unexpected Global Health Experience In Manila, 2020 Children's Mercy Hospital
An Unexpected Global Health Experience In Manila, Susan Mcanany
Posters
Describes her experience in the NICU of the Fabella Memorial Hospital in Manila, Philippines.
Point-Of-Care Versus Central Testing Of Hemoglobin During Large Volume Blood Transfusion., 2019 Thomas Jefferson University
Point-Of-Care Versus Central Testing Of Hemoglobin During Large Volume Blood Transfusion., Justin Herman, Brian Park, Bharat K. Awsare, Frances Mae West, Denine Crittendon, Lilah Evans, Mary Harach, Julie Karp, Alexis R. Peedin, Marianna Lanoue, Barbara Goldsmith, Eugene P. Warnick, Michael Baram
Division of Pulmonary and Critical Care Medicine Faculty Papers
BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions.
METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min …
The Use Of Probiotics To Prevent Ventilator-Associated Pneumonia In Adults, 2019 James Madison University
The Use Of Probiotics To Prevent Ventilator-Associated Pneumonia In Adults, Michael Roper, Paige Douthett
Physician Assistant Capstones, 2016 to 2019
Objective: To assess the efficacy and safety of preventing the acquisition of ventilator- associated pneumonia with the use of probiotic supplementation, as compared to a placebo, among hospitalized adult men and women receiving more than 24 hours of mechanical ventilation. Design: Systematic Literature Review. Methods: Systematic searches were conducted through PubMed and Scopus using the search terms “ventilator”, “probiotics”, and “prevention”. Records were excluded from the analysis if they were published before 2015, full text was not available, studies other than randomized control trial or cohort studies, and if the study population was less than 18 years old. Results: Of …
Chronic Muscle Weakness And Mitochondrial Dysfunction In The Absence Of Sustained Atrophy In A Preclinical Sepsis Model, 2019 University of Kentucky
Chronic Muscle Weakness And Mitochondrial Dysfunction In The Absence Of Sustained Atrophy In A Preclinical Sepsis Model, Allison M. Owen, Samir P. Patel, Jeffrey D. Smith, Beverly K. Balasuriya, Stephanie F. Mori, Gregory S. Hawk, Arnold J. Stromberg, Naohide Kuriyama, Masao Kaneki, Alexander G. Rabchevsky, Timothy A. Butterfield, Karyn A. Esser, Charlotte A. Peterson, Marlene E. Starr, Hiroshi Saito
Physiology Faculty Publications
Chronic critical illness is a global clinical issue affecting millions of sepsis survivors annually. Survivors report chronic skeletal muscle weakness and development of new functional limitations that persist for years. To delineate mechanisms of sepsis-induced chronic weakness, we first surpassed a critical barrier by establishing a murine model of sepsis with ICU-like interventions that allows for the study of survivors. We show that sepsis survivors have profound weakness for at least 1 month, even after recovery of muscle mass. Abnormal mitochondrial ultrastructure, impaired respiration and electron transport chain activities, and persistent protein oxidative damage were evident in the muscle of …
Implementation Of Liberate Protocol With Focus On Delirium In An Acute Care Community Hospital’S Medical And Cardiovascular Intensive Care Units, 2019 Lima Memorial Health System
Implementation Of Liberate Protocol With Focus On Delirium In An Acute Care Community Hospital’S Medical And Cardiovascular Intensive Care Units, Jasmine M. Hossler, Emily A. Sedio, Karen L. Kier
Pharmacy Faculty Scholarship
No abstract provided.