Digital Commons Network^™

A Risk Score For Identifying Methicillin-Resistant Staphylococcus Aureus In Patients Presenting To The Hospital With Pneumonia., Andrew F. Shorr, Daniela E. Myers, David B. Huang, Brian H. Nathanson, Matthew F. Emons, Marin H. Kollef

Emergency Medicine Faculty Publications

Background

Methicillin-resistant Staphylococcus aureus (MRSA) represents an important pathogen in healthcare-associated pneumonia (HCAP). The concept of HCAP, though, may not perform well as a screening test for MRSA and can lead to overuse of antibiotics. We developed a risk score to identify patients presenting to the hospital with pneumonia unlikely to have MRSA.

Methods

We identified patients admitted with pneumonia (Apr 2005 – Mar 2009) at 62 hospitals in the US. We only included patients with lab evidence of bacterial infection (e.g., positive respiratory secretions, blood, or pleural cultures or urinary antigen testing). We determined variables independently associated with the …

Rapid 13(C) Urea Breath Test To Identify Helicobacter Pylori Infection In Emergency Department Patients With Upper Abdominal Pain, Andrew C. Meltzer, Rebecca Pierce, Derek A.T. Cummings, Jesse M. Pines, Larissa May, Meaghan A. Smith, Joseph Marcotte, Melissa L. Mccarthy

Emergency Medicine Faculty Publications

Introduction: In emergency department (ED) patients with upper abdominal pain, management includes ruling out serious diseases and providing symptomatic relief. One of the major causes of upper abdominal pain is an ulcer caused by Helicobacter pylori (H. pylori), which can be treated and cured with antibiotics. We sought to estimate the prevalence of H. pylori infection in symptomatic patients using a convenience sample at a single urban academic ED and demonstrate the feasibility of ED-based testing.

Methods: We prospectively enrolled patients with a chief complaint of pain or discomfort in the upper abdomen for 1 year from February …

History And Hope: The International Humanitarian Reader, Kevin M. Cahill, M.D.

Institute of International Humanitarian Affairs

History and Hope: The International Humanitarian Reader provides a better understanding—both within and outside academia—of the multifaceted demands posed by humanitarian assistance programs. The Reader is a compilation of the most important chapters in the twelve-volume International Humanitarian Affairs book series published by Fordham University Press. Each selected chapter has been edited and updated. In addition, the series editor, Kevin M. Cahill, M.D., has written, among other chapters, an introductory essay explaining the academic evolution of the discipline of humanitarian assistance. It focuses on the “Fordham Experience”: its Institute of International Humanitarian Affairs (IIHA) has developed practical programs for training …

Practice Characteristics Of Graduates Of East Tennessee State University Quillen College Of Medicine: Factors Related To Career Choices In Primary Care, Ivy A. Click

Electronic Theses and Dissertations

The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State University Quillen College of Medicine including factors that influence graduates’ specialty choices and practice locations, especially those related to primary care. Secondary data for this study were collected from the college’s student database system and the American Medical Association Physician Masterfile. The study population included …

Oncolog, Volume 58, Number 05, May 2013, Jill Delsigne, Bryan Tutt

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Robotic Surgery Makes Tissue Harvest for Breast Reconstruction Less Invasive: A new minimally invasive robotic procedure enables surgeons to harvest latissimus dorsi muscle flaps for breast reconstruction with less scarring and discomfort than traditional techniques
• Diagnosis and Treatment of Invasive Fungal Infections in patients with Hematological Malingnancies: Invasive fungal infections are important causes of morbidity and death for patients with hematological malignancies. Although much progress has been made in the management of opportunistic fungal infections, their diagnosis and treatment remain a challenge
• INBRIEF: Beta-Blocker Use Associated With Higher Survival Rates in Lung Cancer Patients Receiving Radiation Therapy/ Selumetinib Shows Promise …

Listeria Monocytogenes Cholecystitis: A Possible New Syndrome., Jackrapong Bruminhent, Timothy K Lynch, Jonathan Gefen, Jerome Santoro

Division of Internal Medicine Faculty Papers & Presentations

: The U.S. Food and Drug Administration recently added potentially fatal Listeria monocytogenes infection to the list of opportunistic infections that can occur in patients who receive tumor necrosis factor inhibitor therapy. In this study, the first reported case of L monocytogenes cholecystitis associated with etanercept use is described. It also appears that tumor necrosis factor inhibitor therapy likely increases the risk for Listeria cholecystitis. Clinicians need to be aware of this association when selecting antimicrobial therapy for these patients.

Beliefs About Complementary And Alternative Medicine In Hiv-Infected Black Women Using The Theory Of Planned Behavior, Stephanie G. Lino

Loma Linda University Electronic Theses, Dissertations & Projects

Background. Black women make up 12% of the female population in the U.S, yet they account for 66% of new HIV infections. In 2002, AIDS was the most cited reason for death among Black women age 25-34. While prevention remains, a major effort targeting treatment efficacy and modalities for this sub-group need to be better understood.

Purpose. The purpose of this study is to assess whether HIV-positive Black women’s attitudes, subjective norms and perceived behavioral control are related to intention of dietary supplements and spiritual practices use in their HIV treatment.

Method. In phase one, Grounded Theory methods (N= …

Antibody Quality And Protection From Lethal Ebola Virus Challenge In Nonhuman Primates Immunized With Rabies Virus Based Bivalent Vaccine., Joseph E Blaney, Andrea Marzi, Mallory Willet, Amy B Papaneri, Christoph Wirblich, Friederike Feldmann, Michael Holbrook, Peter Jahrling, Heinz Feldmann, Matthias J Schnell

Department of Microbiology and Immunology Faculty Papers

We have previously described the generation of a novel Ebola virus (EBOV) vaccine platform based on (a) replication-competent rabies virus (RABV), (b) replication-deficient RABV, or (c) chemically inactivated RABV expressing EBOV glycoprotein (GP). Mouse studies demonstrated safety, immunogenicity, and protective efficacy of these live or inactivated RABV/EBOV vaccines. Here, we evaluated these vaccines in nonhuman primates. Our results indicate that all three vaccines do induce potent immune responses against both RABV and EBOV, while the protection of immunized animals against EBOV was largely dependent on the quality of humoral immune response against EBOV GP. We also determined if the induced …

Characterization Of Differentiation And Prognostic Biomarkers On Cd8+ Tumor-Infiltrating Lymphocytes In Metastatic Melanoma, Richard C. Wu

Dissertations and Theses (Open Access)

CD8⁺ cytotoxic T lymphocytes (CTL) frequently infiltrate tumors, yet most melanoma patients fail to undergo tumor regression. We studied the differentiation of the CD8⁺ tumor-infiltrating lymphocytes (TIL) from 44 metastatic melanoma patients using known T-cell differentiation markers. We also compared CD8⁺ TIL against the T cells from matched melanoma patients’ peripheral blood. We discovered a novel subset of CD8⁺ TIL co-expressing early-differentiation markers, CD27, CD28, and a late/senescent CTL differentiation marker, CD57. This CD8⁺CD57⁺ TIL expressed a cytolytic enzyme, granzyme B (GB), yet did not express another cytolytic pore-forming molecule, perforin (Perf). In …

Neuropathogenic Escherichia Coli K1 Does Not Exhibit Proteolytic Activities To Exert Its Pathogenicity, Junaid Iqbal, Mehak Rajan, Ruqaiyyah Siddiqu, Naveed Ahmed Khan

Department of Biological & Biomedical Sciences

Background: Proteases are well-known virulence factors that promote survival, pathogenesis and immune evasion of many pathogens. Several lines of evidence suggest that the blood-brain barrier permeability is a prerequisite in microbial invasion of the central nervous system. Because proteases are frequently associated with vascular permeability by targeting junctional proteins, here it is hypothesized that neuropathogenic Escherichia coli K1 exhibit proteolytic activities to exert its pathogenicity.
Methods: Zymographic assays were performed using collagen and gelatin as substrates. The lysates of whole E. coli K1 strain E44, or E. coli K-12 strain HB101 were tested for proteolytic activities. The conditioned media were …

Effects Of Clostridium Difficile On The Human Immune Response, Mike Mcgovern

Honors Projects in Science and Technology

Clostridium difficile is a bacterium that is rapidly becoming a large issue in the medical community due to its tendency to infect hospital patients and its resistance to antibiotics. By studying the way in which the pathogen interacts with the human immune system, it is possible to better understand how the body naturally fights off the disease. This knowledge can allow medical professionals to develop treatments that can help curtail the infection before serious symptoms occur. Working under a grant program alongside Professors Kirsten Hokeness and Chris Reid, I was able to research the effects that exposure to the C. …

Patient-Driven Resource Planning Of A Health Care Facility Evacuation, Bruno P. Petinaux, Kabir Yadav

Emergency Medicine Faculty Publications

Introduction: The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old.

Methods: Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period.

Results: Survey data were collected on 2,050 patients. Units with patients …

Prevalence And Risk Factor Analysis Of Resistant Escherichia Coli Urinary Tract Infections In The Emergency Department, Abby M. Bailey, Kyle A. Weant, Stephanie N. Baker

Emergency Medicine Faculty Publications

BACKGROUND: Escherichia coli (E. coli) is a frequent uropathogen in urinary tract infections (UTI). Widespread resistance to sulfamethoxazole-trimethoprim (SMX-TMP) and increasing resistance to fluoroquinolones amongst these isolates has been recognized. There are limited data demonstrating risk factors for resistance to both SMX-TMP and fluoroquinolones.

OBJECTIVE: This study was conducted to assess for the prevalence of community resistance amongst E. coli isolates to SMX-TMP and levofloxacin in ambulatory patients discharged from the emergency department (ED).

METHODS: Adults presenting for evaluation and discharged from the ED with a diagnosis of an E. coli UTI were retrospectively reviewed. Utilizing demographic and clinical data …

Perception Of Disease Risk And Vulnerability As A Function Of Proximity To National Park Boundaries In East Africa, Irene Bridget Feretti

Honors Theses and Capstones

Studies suggest households closest to parks and protected areas (PAs) are more likely to sustain park-related losses, but the relationship between human sickness and PAs has not been fully explored. Existing literature primarily focuses on human-wildlife conflicts (i.e. crop raiding) and the potential for zoonotic disease spillover and emergence at the human-livestock-wildlife interface at PA boundaries. Understanding local perceptions of disease risk and vulnerability is essential for assessing human health relative to conservation areas. This understanding will promote better-informed consideration of human health impacts in decision making for conservation. Data from surveys taken at 301 households around Kibale National Park …

Coital Frequency And Condom Use In Monogamous And Concurrent Sexual Relationships In Cape Town, South Africa, Wim Delva, Fei Meng, Roxanne Beauclair, Nele Deprez, Marleen Temmerman, Alex Welte, Niel Hens

Obstetrics and Gynaecology, East Africa

Introduction: A decreased frequency of unprotected sex during episodes of concurrent relationships may dramatically reduce the role of concurrency in accelerating the spread of HIV. Such a decrease could be the result of coital dilution - the reduction in per-partner coital frequency from additional partners - and/or increased condom use during concurrency. To study the effect of concurrency on the frequency of unprotected sex, we examined sexual behaviour data from three communities with high HIV prevalence around Cape Town, South Africa.

Methods: We conducted a cross-sectional survey from June 2011 to February 2012 using audio computer-assisted self-interviewing to reconstruct one-year …

Interventions To Reduce Neonatal Mortality From Neonatal Tetanus In Low And Middle Income Countries - A Systematic Review, Adeel Ahmed Khan, Aysha Zahidie, F. Rabbani

Community Health Sciences

Background

In 1988, WHO estimated around 787,000 newborns deaths due to neonatal tetanus. Despite few success stories majority of the Low and Middle Income Countries (LMICs) are still struggling to reduce neonatal mortality due to neonatal tetanus. We conducted a systematic review to understand the interventions that have had a substantial effect on reducing neonatal mortality rate due to neonatal tetanus in LMICs and come up with feasible recommendations for decreasing neonatal tetanus in the Pakistani setting.

Methods

We systemically reviewed the published literature (Pubmed and Pubget databases) to identify appropriate interventions for reducing tetanus related neonatal mortality. A total …

Infective Endocarditis In The U.S., 1998–2009: A Nationwide Study, David H. Bor, Steffie Woolhandler, Rachel Nardin, David Brusch, David U. Himmelstein

Publications and Research

Background
Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population. Small-scale studies elsewhere have reported similar incidence rates. However, no nationally-representative population-based studies have verified these estimates.

Methods and Findings
Using the 1998–2009 Nationwide Inpatient Sample, which provides diagnoses from about 8 million U.S. hospitalizations annually, we examined endocarditis hospitalizations, bacteriology, co-morbidities, outcomes and costs. Hospital admissions for endocarditis rose from 25,511 in 1998 to 38, 976 in 2009 (12.7 per 100,000 population in 2009). The age-adjusted endocarditis admission rate increased 2.4% annually. The proportion of patients …

Disseminating Childhood Home Injury Risk Reduction Information In Pakistan: Results From A Community-Based Pilot Study, Aruna Chandran, Uzma Rahim Khan, Nukhba Zia, Asher Feroze, Sarah Stewart De Ramirez, Cheng-Ming Huang, Junaid A. Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools.

Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. …

Pathogen-Specific Risk Of Chronic Gastrointestinal Disorders Following Bacterial Causes Of Foodborne Illness, Chad K. Porter, Daniel Choi, Brooks Cash, Mark Pimentel, Joseph Murray, Larissa May, Mark S. Riddle

Emergency Medicine Faculty Publications

Background

The US CDC estimates over 2 million foodborne illnesses are annually caused by 4 major enteropathogens: non-typhoid Salmonella spp., Campylobacter spp., Shigella spp. and Yersinia enterocoltica. While data suggest a number of costly and morbid chronic sequelae associated with these infections, pathogen-specific risk estimates are lacking. We utilized a US Department of Defense medical encounter database to evaluate the risk of several gastrointestinal disorders following select foodborne infections.

Methods

We identified subjects with acute gastroenteritis between 1998 to 2009 attributed to Salmonella(nontyphoidal) spp., Shigella spp., Campylobacter spp. or Yersinia enterocolitica and matched each with up to 4 …

Broadening Access To Medical Care During A Severe Influenza Pandemic: The Cdc Nurse Triage Line Project., Lisa M. Koonin, Dan Hanfling

Emergency Medicine Faculty Publications

The impact of a severe influenza pandemic could be overwhelming to hospital emergency departments, clinics, and medical offices if large numbers of ill people were to simultaneously seek care. While current planning guidance to reduce surge on hospitals and other medical facilities during a pandemic largely focuses on improving the “supply” of medical care services, attention on reducing “demand” for such services is needed by better matching patient needs with alternative types and sites of care. Based on lessons learned during the 2009 H1N1 pandemic, the Centers for Disease Control and Prevention and its partners are currently exploring the acceptability …

First Steps Phase I Initiative: Improving Immunizations For Children And Adolescents, Kimberley S. Fox Mpa, Carolyn E. Gray Mph

Population Health & Health Policy

This evalution report, authored by research staff at the USM Muskie School, assesses the change in immunization rates in participating pediatric and family practices that serve a high volume of children insured by MaineCare (Maine's Medicaid system). The authors also summarize lessons learned in implementing changes in practices and challenges in using the immunization measures at the practice-level to inform quality improvement.

Lps And Pan-Induced Podocyte Injury In An In Vitro Model Of Minimal Change Disease: Changes In Tlr Profile., Tarak Srivastava, Mukut Sharma, Kok-Hooi Yew, Ram Sharma, R Scott Duncan, Moin A. Saleem, Ellen T. Mccarthy, Alexander Kats, Patricia A. Cudmore, Uri S. Alon, Christopher J. Harrison

Manuscripts, Articles, Book Chapters and Other Papers

Minimal change disease (MCD), the most common idiopathic nephrotic syndrome in children, is characterized by proteinuria and loss of glomerular visceral epithelial cell (podocyte) ultrastructure. Lipopolysaccharide (LPS) and puromycin aminonucleoside (PAN) are used to study podocyte injury in models of MCD in vivo and in vitro. We hypothesized that LPS and PAN influence components of the innate immune system in podocytes such as the Toll-Like Receptor (TLRs), TLR adapter molecules, and associated cytokines. Our results show that cultured human podocytes constitutively express TLRs 1-6 and TLR-10, but not TLRs 7-9. LPS (25 μg/ml) or PAN (60 μg/ml) caused comparable derangement …

Elevated Chemerin Levels In Pakistani Men: An Interrelation With Metabolic Syndrome Phenotypes, Syeda Sadia Fatima, Kiymet Bozaoglu, Rehana Rehman, Faiza Alam, Abdul Shakoor Memon

Department of Biological & Biomedical Sciences

Chemerin is a novel protein linked to adipocyte differentiation and the development of metabolic imbalances. We sought to examine the relationship of chemerin with metabolic syndrome disturbances including body fat percentage, serum lipid, glucose, insulin levels and body fat percentage in lean and obese volunteers. A cross-sectional study of 90 randomly selected healthy males from Pakistan were divided into three groups as per Body Mass Index (BMI) criteria for South Asian Population. Anthropometric measurements were taken for BMI, waist circumference, hip circumference and body fat percentage, while serum analyses were performed for fasting blood glucose, fasting insulin, fasting lipid profile …

Age-Related Accumulation Of T Cells With Markers Of Relatively Stronger Autoreactivity Leads To Functional Erosion Of T Cells., Zohreh Tatari-Calderone, Milica Stojakovic, Ramita Dewan, Gama L. Bouder, Dragana Jankovic, Stanislav Vukmanovic

Pediatrics Faculty Publications

Background

Thymic involution is a prominent characteristic of an aging immune system. When thymic function is reduced/absent, the peripheral T cell pool is subject to the laws of peripheral T cell homeostasis that favor survival/expansion of T cell receptors with relatively higher functional avidity for self-peptide/MHC complexes. Due to difficulties in assessing the TCR avidity in polyclonal population of T cells, it is currently not known whether high avidity T cells preferentially survive in aging individuals, and what impact this might have on the function of the immune system and development of autoimmune diseases.

Results

The phenotype of T cells …

The Treatment Of Cutaneous Abscesses: Comparison Of Emergency Medicine Providers' Practice Patterns, Gillian Schmitz, Tress Goodwin, Adam Singer, Chad S. Kessler, David Bruner, Hollyn Larabee, Larissa S. May, Samuel D. Luber, Justin Williams, Rahul Bhat

Emergency Medicine Faculty Publications

INTRODUCTION:

Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting.

METHODS:

Four hundred and seventy-four …

Inflammatory Biomarker Changes And Their Correlation With Framingham Cardiovascular Risk And Lipid Changes In Antiretroviral-Naive Hiv-Infected Patients Treated For 144 Weeks With Abacavir/Lamivudine/Atazanavir With Or Without Ritonavir In Aries., Benjamin Young, Kathleen E Squires, Lisa L Ross, Lizette Santiago, Louis M Sloan, Henry H Zhao, Brian C Wine, Gary E Pakes, David A Margolis, Mark S Shaefer

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Propensity for developing coronary heart disease (CHD) is linked with Framingham-defined cardiovascular risk factors and elevated inflammatory biomarkers. Cardiovascular risk and inflammatory biomarkers were evaluated in ARIES, a Phase IIIb/IV clinical trial in which 515 antiretroviral-naive HIV-infected subjects initially received abacavir/lamivudine + atazanavir/ritonavir for 36 weeks. Subjects who were virologically suppressed by week 30 were randomized 1:1 at week 36 to either maintain or discontinue ritonavir for an additional 108 weeks. Framingham 10-year CHD risk scores (FRS) and risk category of

Oncolog, Volume 58, Number 02, February 2013, Bryan Tutt, Jill Delsigne

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Chronic Viral Hepatitis in Cancer Patients Requires Personalized Management: Chronic viral hepatitis is life-threatening for many patients but curable or manageable for others. But in patients who have both viral hepatitis and cancer, cancer treatment may exacerbate the viral infection and lead to other complications, such as liver failure or even death
• Managing Sleep Disorders in Cancer Patients: Quality sleep is essential to healing, to proper immune function, and even to mental health. Conversely, lack of sleep has been associated with depression, anxiety, and decreased cognitive function. In cancer patients, poor sleep reduces quality of life; nevertheless, most cancer patients …

Comparison Of Clinical And Csf Profiles In Children With Tuberculous And Pyogenic Meningitis; Role Of Csf Protein: Glucose Ratio As Diagnostic Marker Of Tuberculous Meningitis, Farah Naz Qamar, Arshalooz Jamila Rahman, Sania Iqbal, Khadija Humayun

Department of Paediatrics and Child Health

Objectives: To compare the clinical and laboratory features of tuberculous meningitis with bacterial meningitis and to determine if protein glucose ratio in the cerebrospinal fluid can be predictive of the condition.
Methods: It was a retrospective descriptive study at the Paediatric Ward of Aga Khan University Hospital, Karachi, for which records of 46 patients with tuberculous meningitis and 33 with bacterial meningitis were reviewed. All records related to the study period that was from January 2005 to October 2010. The records were retrieved in December 2010. Tuberculous meningitis was defined as illness > or = 14 days, basal enhancement or tuberculoma …

A Case Of Orbital Apex Syndrome In A Patient With Malignant Otitis Externa, Rashid Baig, Qazi Assad Khan, Mohammed Ali Sadiq, Mohammad Sohail Awan, Khabir Ahmad

Department of Surgery Docs

Abstract

A rare case of skull base infection with a rapid clinical course leading to visual loss and eventually death in a poorly-controlled diabetic patient is presented. A 37-year-old woman presented with a history of visual loss and painful protrusion of the right eye for the preceding 3 days.This was accompanied by vertigo and right-side facial weakness. The patient had perception of light in her right eye and 20/25 (presenting visual acuity) in the fellow eye, accompanied by right-side proptosis, total ophthalmoplegia, optic disc pallor and central retinal artery occlusion. Magnetic resonance imaging showed the presence of oedema with soft-tissue …

Etiology And Outcome Of Severe Community Acquired Pneumonia In Immunocompetent Adults., Ali Khawaja, Ali Bin Sarwar Zubairi, Fahad Khan Durrani, Afia Zafar

Department of Medicine

BACKGROUND: Community Acquired Pneumonia (CAP) is a commonly encountered disease, one third of which is Severe Community Acquired Pneumonia (SCAP) that can be potentially fatal. There is a paucity of data on etiology and outcome of patients with SCAP in South Asian Population.

METHODS: A retrospective cross-sectional study was conducted from March 2002 till December 2008 on patients of 16 years and above who were admitted with the diagnosis of SCAP in accordance to the criteria of American Thoracic Society Guidelines (2001). The patients underwent clinical and diagnostic evaluations to detect the severity of illness as well as the etiology …