Digital Commons Network^™

Chemical Space Exploration Around Thieno[3,2-D]Pyrimidin-4(3h)-One Scaffold Led To A Novel Class Of Highly Active Clostridium Difficile Inhibitors, Xuwei Shao

Theses and Dissertations

Clostridium difficile infection (CDI) is the leading cause of healthcare-associated infection in the United States. Therefore, development of novel treatments for CDI is a high priority. Toward this goal, we began in vitro screening of a structurally diverse in-house library of 67 compounds against two pathogenic C. difficile strains (ATCC BAA 1870 and ATCC 43255), which yielded a hit compound, 2-methyl-8-nitroquinazolin-4(3H)-one (2) with moderate potency (MIC = 312/156 µM). Optimization of 2 gave lead compound 6a (2-methyl-7-nitrothieno[3,2-d]pyrimidin-4(3H)-one) with improved potency (MIC = 19/38 µM), selectivity over normal gut microflora, CC50s >606 µM against mammalian cell lines, and acceptable stability in …

College Of Pharmacy 2020, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

Bill Gatton College Of Pharmacy Viewbook - 2020, Bill Gatton College Of Pharmacy, East Tennessee State University

Bill Gatton College of Pharmacy Miscellaneous Publications

No abstract provided.

A Case Of Tetanus With Classical Presentations, Maaz Khan, Dr. Bhanukumar M

Digital Journal of Clinical Medicine

No abstract provided.

Anaphylaxis Diagnosis And Management In The Emergency Department Of A Tertiary Hospital In The Philippines, Michelle Joy De Vera, Iris Conela Tagaro

Ateneo School of Medicine and Public Health Publications

Background:
In the Emergency Department (ED), diagnosis and management of anaphylaxis are challenging with at least 50% of anaphylaxis episodes misdiagnosed when the diagnostic criteria of current guidelines are not used.

Objective:
Objective of our study was to assess anaphylaxis diagnosis and management in patients presenting to the ED.

Methods:
Retrospective chart review conducted on patients presenting to The Medical City Hospital ED, the Philippines from 2013–2015 was done. Cases were identified based on International Statistical Classification of Diseases, 10th revision coding for either anaphylaxis or other allergic related diagnosis. Cases fitting the definition of anaphylaxis as identified by the …

Evaluating Appropriateness And Diagnostic Stewardship Opportunities Of Multiplex Polymerase Chain Reaction Gastrointestinal Testing Within A Hospital System, Melissa O'Neal, Hanna Murray, Sangita Dash, Majdi N. Al-Hasan, Julie Ann Justo, P Brandon Bookstaver

Faculty Publications

Objective: This single-center, retrospective, observational cohort study evaluates the appropriateness of the BioFire® FilmArray® Gastrointestinal (GI) multiplex PCR panel testing at a community-teaching hospital. Methods: All adult, hospitalized patients at Prisma Health Richland Hospital with a documented GI multiplex PCR panel from 1 April 2015 through 28 February 2018 were included in the analysis. Inappropriate use of the GI panel was defined as a test obtained without documented diarrhea, greater than 2 days of hospitalization, redundant use with other diagnostic tests (e.g. PCR), or laxative use in the preceding 48 h. Antibiotic use and host variables were compared between groups …

Online Availability Of Fish Antibiotics And Documented Intent For Self-Medication, Weiwei Zhang, Austin Williams, Nicole Griffith, Jessica Gaskins, P Brandon Bookstaver

Faculty Publications

Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of …

Vancomycin Dosing Practices Among Critical Care Pharmacists: A Survey Of Society Of Critical Care Medicine Pharmacists, Alexander H. Flannery, Drayton A. Hammond, Douglas R. Oyler, Chenghui Li, Adrian Wong, Andrew P. Smith, Qiu Min Yeo, Whitney Chaney, Caitlin E. Pfaff, Angela M. Plewa-Rusiecki, Paul Juang

Pharmacy Practice and Science Faculty Publications

Introduction: Critically ill patients and their pharmacokinetics present complexities often not considered by consensus guidelines from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Prior surveys have suggested discordance between certain guideline recommendations and reported infectious disease pharmacist practice. Vancomycin dosing practices, including institutional considerations, have not previously been well described in the critically ill patient population.

Objectives: To evaluate critical care pharmacists' self-reported vancomycin practices in comparison to the 2009 guideline recommendations and other best practices identified by the study investigators.

Methods: An online survey developed by the …

Utilization Of A Community Pharmacy-Based Service For The Treatment Of Uncomplicated Urinary Tract Infections In Scotland, Robert Borchardt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: In November 2013, Scotland piloted a program in Grampian for the treatment of Urinary Tract Infections (UTIs) in community pharmacies, increasing health access for patients and reducing general practitioner workload. This program became known as ‘Pharmacy First’ and was later implemented nationwide in November 2017. This paper seeks to understand utilization of the Pharmacy First program across Scotland by patients and potential barriers to access.

Methods: Using data from the Prescribing Information System collected by the National Health Service of Scotland from July 2013 to April 2019, orders for uncomplicated UTIs were gathered by examining all nitrofurantoin and trimethoprim …

Dalbavancin In The Community Emergency Department, Wesley Johnson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction

Dalbavancin is an antibiotic within the class of medications known as lipoglycopeptides. This medication is given to patients presenting to the hospital with acute skin and skin-structure infections (ABSSSI). This is a unique medication because it is given as a one-time dose in the outpatient setting and it could prevent patients from requiring admission to the hospital.

Methods

The emergency department (ED) at Good Samaritan community hospital performed a trial period with dalbavancin and data was collected from November 2018 to March 2020. Retrospective chart review was performed to obtain patient data and outcomes. Patients would be contacted by …

The Impact Of Bone Marrow Transplantion On Patients With Psychiatric Diagnoses: Medication Adherence Assessment, Brittany Galop

Theses and Dissertations--Pharmacy

Objectives: We investigated whether there is a measurable difference in medication utilization for psychiatric conditions before and after bone marrow transplantation (BMT). Previous studies have identified a potential association between psychiatric conditions and immune function. We hypothesized that medication utilization for psychiatric diagnoses would be impacted by BMT.

Methods: This study was a retrospective, quasi-experimental cohort design. De-identified data was compiled from the Truven database for patients ranging from January 2009 through December 2016. Two measurements of medication utilization, proportion of days covered (PDC) and medication possession ratio (MPR) were calculated for each included Medispan-defined class of medications before analyzing …

Extensively Drug-Resistant Pseudomonas Aeruginosa In Vitro Susceptibility And Mechanisms Of Resistance, Chanah Gallagher

Theses and Dissertations--Pharmacy

Pseudomonas aeruginosa causes severe healthcare-associated infections. Forty-eight extensively drug-resistant (XDR)-P. aeruginosa isolates were selected from 287 isolates collected for evaluation based on clinical susceptibility data. In vitro activity of commonly utilized antimicrobials (i.e. antipseudomonal beta-lactams, aminoglycosides, fluoroquinolones, and polymyxins) plus ceftolozane-tazobactam, ceftazidime-avibactam, and aztreonam-avibactam against XDR-P. aeruginosa were determined. The mechanism of resistance profile was determined through phenotypic expression analysis. Overall, polymyxin B and colistin were 100% susceptible. Apart from the polymyxins, ceftolozane-tazobactam had the highest susceptibility (94%) followed by ceftazidime-avibactam (90%) and amikacin (83%). Ceftolozane-tazobactam activity was not significantly different from ceftazidime-avibactam (p=0.6831). Only 40% of isolates …

A Case Of Mixed Anxiety Depression In The Covid-19 Lockdown, Dr Hrishikesh Solunke, Dr Kishor M

Digital Journal of Clinical Medicine

No abstract provided.

Tuberculoma Presenting As Paradoxical Iris In A Hiv Positive Patient, Dr. Supritha Chintamaneni, Dr.Rajendra Prasad S, Dr.Bhanukumar M, Dr.Adarsh L S

Digital Journal of Clinical Medicine

No abstract provided.

Vaccine Hesitancy: Experimentalism As Regulatory Opportunity, Ana Santos Rutschman, Timothy L. Wiemken

All Faculty Scholarship

This symposium on patient innovation has prompted us to explore problems related to departures from official vaccination schedules. At a time in which vaccine confidence has been plummeting across the world, we argue that a more granular understanding—and ultimately a more finely tuned regulatory framework—is needed to reflect the current behavioral heterogeneity among indicated patients who choose to forego or delay administration of recommended vaccines. In particular, we focus on a phenomenon we term “vaccine staggering:” a departure from vaccination schedules in the form of delays in receiving one or more vaccines, which is motivated by the desire to boost …

Evaluating The Impact Of Verigene® Organism Identification On Antimicrobial Stewardship Recommendations, Rebecca Gerske

Undergraduate Honors Thesis Collection

Verigene® is one of many commercially available rapid diagnostic tests (RDT) for organism identification in blood culture. Community Health Network (CHNw) utilizes this system to identify blood cultures and guide antimicrobial therapy. As antibiotic resistance becomes more and more prevalent, limiting exposure to broad-spectrum antibiotic therapy is of paramount importance. RDT provides more timely information to providers, which if utilized appropriately, can result in the patient receiving appropriate antibiotic therapy in a shorter time and further limits unnecessary antibiotic exposure. This study was a three-part, retrospective chart review to determine the microbiological accuracy of Verigene® within CHNw and evaluate the …

Enhancing Chemosensitivity Of Lung Cancers By Manipulating The Tumor Microenvironment: Local Lung Delivery And Nanocarrier-Based Therapies, Hanming Zhang

Theses and Dissertations

Cancer is the second leading cause of death in United States causing an estimated six hundred thousand death in 2019. Among different types of cancer, lung cancer is the leading cause of cancer related death in both male and female. While targeted therapy and immunotherapy have shown promising clinical outcomes, currently there remain a significant proportion of patients who do not benefit from these strategies or who cannot tolerate them, making Pt based doublet chemotherapy still an indispensable component in almost all stages of treatment. However, partially due to the poor tumor distribution of small molecule drug, the development of …

Development Of A Screening Assay For Type Iii Secretion System Inhibitors And High Throughput Screening Campaign Of Inhibitors Of Prp Of Staphylococcus Aureus, Heather A. Pendergrass

Theses and Dissertations

Antibiotics inhibit the growth or survival of bacteria by targeting their essential functions.¹ Due to weaknesses in traditional antibiotics and the increasing prevalence of antibiotic resistance genes, virulence factors are being targeted for therapeutic treatment of bacterial infection.² We have developed an assay to quantify and observe type III secretion system (T3SS) activity. The type III secretion system (T3SS) is a virulence factor present in some Gram-negative pathogens including enteropathogenic and enterohemorrhagic E. coli (EPEC and EHEC, respectively),³ and others.^4–9 The T3SS between EPEC and EHEC are highly conserved and share over 90% sequence identity with …

Antioxidant And Antimicrobial Activities Of Crude Extracts Of Actinomycetes From Soils, Khaing Zar Wai

Chulalongkorn University Theses and Dissertations (Chula ETD)

A total of 17 actinomycetes isolated from soil collected from Nong Khai, Nakhon Ratchasima, Khon Kaen, Phichit, Chachoengsao and Udonthani Province, were evaluated on antimicrobial and antioxidant activities. They were identified as Streptomyces (16 strains) and Micromonospora (1 strain) based on their phenotypic and chemotaxonomic characteristics including 16S rRNA gene sequences analysis. Strain JA03 showed 98.95% similarity of 16S rRNA gene sequence to S. puniciscabiei DSM 41929T. Strain JA03 was found to be the novel species of genus Streptomyces based on whole genome average nucleotide identity (ANI). All these strains were evaluated on antimicrobial and antioxidant activities. Based on agar …

Kikuchi-Fujimoto Disease, Rohan Karkra

Digital Journal of Clinical Medicine

No abstract provided.

Phytochemical Screening, In Vitro Antimalarial Activity And Genetic Diversity Of Selected Asteraceae Medicinal Plants Indigenous To Thailand, Desy Liana

Chulalongkorn University Theses and Dissertations (Chula ETD)

The emergence of artemisinin resistance leaded the effort to find the new antimalarial drug or artemisinin activity booster. Due to the chance that secondary metabolites can be evolutionary conserved, combining phylogeny with ethnobotanical data for screening antimalarial activity may be helpful to predict bioactivity and minimize the expenditure and time for laboratory research. The aimed of this study is screening the antimalarial activity, phytochemicals and genetic diversity of selected Asteraceae medicinal plants generated by combinatorial phylogeny and ethnobotanical data. 733 medicinal plants were obtained from literature search however only 340 taxa were met the inclusion and exclusion criteria hence these …

ผลกระทบของการรักษาด้วยยาต้านรีโทรไวรัสต่ออุบัติการณ์โรคปอดอักเสบนิวโมซิสติสปฐมภูมิในผู้ใหญ่ติดเชื้อเอชไอวี, พิรุณ คำลี

Chulalongkorn University Theses and Dissertations (Chula ETD)

การวิจัยนี้มีวัตถุประสงค์เพื่อเปรียบเทียบอุบัติการณ์การเกิดโรค PCP ปฐมภูมิระหว่างกลุ่มผู้ติดเชื้อเอชไอวีที่ได้รับและไม่ได้รับยาป้องกันโรค PCP ปฐมภูมิตามเกณฑ์เมื่อผู้ป่วยเริ่มรักษาด้วยต้านไวรัสที่มีประสิทธิภาพสูงในช่วงระยะเวลา 48 สัปดาห์ และรายงานอัตราการเกิดอาการไม่พึงประสงค์จากการใช้ยาป้องกันโรค PCP ปฐมภูมิ ใช้วิธีการศึกษารูปแบบ retrospective cohort study โดยทำการเก็บข้อมูลย้อนหลังจากเวชระเบียนผู้ป่วยนอกที่เข้ารับการรักษาการติดเชื้อเอชไอวี ณ โรงพยาบาลศิริราช ผลการศึกษา พบว่า มีกลุ่มตัวอย่างทั้งสิ้น 217 ราย มีค่ามัธยฐานของอายุ 39 ปี เป็นเพศชายร้อยละ 63.1 มีค่ามัธยฐานของระดับ CD4+ เริ่มต้น เท่ากับ 83 เซลล์ต่อไมโครลิตร และมีระยะเวลาติดตามประวัติในการรักษาผู้ป่วยรวมทั้งสิ้น 197.35 คน-ปี มีผู้ป่วยได้รับยาป้องกันโรค PCP ปฐมภูมิตามเกณฑ์ จำนวน 104 ราย (ร้อยละ 47.93) ลักษณะทั่วไประหว่างกลุ่มผู้ป่วยที่ได้รับและไม่ได้รับยาป้องกันโรค PCP ปฐมภูมิ มีค่ามัธยฐานของอายุและระดับ CD4+ เริ่มต้น เท่ากับ 41 ปี : 38 ปี และ 48 เซลล์ต่อไมโครลิตร : 133 เซลล์ต่อไมโครลิตร ตามลำดับ พบผู้ป่วย 1 รายในกลุ่มที่ไม่ได้รับยาป้องกันโรคดังกล่าวเป็นโรค PCP ปฐมภูมิ คิดเป็นอุบัติการณ์โดยรวม เท่ากับ 0.51 ต่อ 100 คน-ปี ผลการวิเคราะห์เปรียบเทียบโอกาสการปลอดโรค PCP ปฐมภูมิระหว่างผู้ป่วย 2 กลุ่มด้วยสถิติ Log-rank test เมื่อปรับค่าตามระดับ CD4+ พบว่า ไม่มีความแตกต่างกันอย่างมีนัยสำคัญทางสถิติ (P-value = 0.133) และพบผู้ป่วยเกิดอาการไม่พึงประสงค์จากการใช้ยาป้องกัน PCP ปฐมภูมิ ร้อยละ 10.58 ของกลุ่มที่ได้รับยาป้อง PCP ปฐมภูมิ โดยส่วนใหญ่พบผู้ป่วยมีอาการข้างเคียงทางผิวหนังและมีอาการข้างเคียงในระดับรุนแรง คือ Stevens-Johnson syndrome …

Development Of Hyaluronic Acid-Based Nanogel Platform For Improved Stability And Polyvalent Ligand Display Of Poly(I:C) As An Effective Immunostimulatory Adjuvant In Cancer Immunotherapy, Nararat Kotcharat

Chulalongkorn University Theses and Dissertations (Chula ETD)

The aim of this research was to develop a nanogel formulation-based on modified natural polymer, hyaluronic acid (HA), as a biodegradable material for adjuvant delivery. Polyinosinic:polycytidylic acid (poly(I:C)) have been approved by FDA as a promising adjuvant candidate for the TLR3 (Toll-Like Receptor 3) activation. However, it suffers from being poor stability and is subjected to rapid enzymatic hydrolysis in serum, so that it requires high administered dose leading to adverse effects. To augment the adjuvant stability and protection from the degradation, the nano-particulate carriers were herein designed with self-assembly of HA scaffold grafted with poly (N-isopropylacrylamide), or pNIPAM. The …

Comparison Of Area Under The Curves For Vancomycin From One- And Two-Compartment Models Using Sparse Data, Nyein Hsu Maung

Chulalongkorn University Theses and Dissertations (Chula ETD)

Vancomycin pharmacokinetics has been described by 1- and 2-compartment models. One-compartment models built from routine monitoring data, which were mainly trough samples, are commonly used to predict area under the curves (AUC), the useful indicator for vancomycin efficacy. The question stands whether AUCs from 1-compartment models with sparse data can sufficiently represent the true AUC. This study aimed to compare AUCs from 1- and 2-compartment models using sparse data. A previously published model was used to simulate full individual profiles for 100 patients. From these data, the reference AUC (AUCref) was calculated and two depleted datasets (trough-only and peak-trough) were …

Development Of Nanoparticle-In-Microsphere(Nimos) System For Oral Delivery Of Vaccine And Antibody Against Ped Virus For Swine, Rachatapan Junchay

Chulalongkorn University Theses and Dissertations (Chula ETD)

PED virus is a major barrier to the animal farming industry, and it is the main cause of the mortality of suckling piglets up to 95% by enteric infection. The 2C10 monoclonal antibody (mAb) obtained from Nicotiana benthamiana produced by transient expression was indicated as one of the potential candidates is an antibody against PEDV by oral delivery. The biologics are a new wave of pharmaceuticals and have been continuously developing, which has various benefits of low toxicity and high specificity. However, it unsuitable for use with oral drug delivery owing to limitations of the strong acidity and protease of …

Population Pharmacokinetics Of Intravenous Colistin In Pediatrics (Poppicop Study), Noppadol Wacharachaisurapol

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Colistin use in pediatrics is surging in line with the increase of multidrug-resistant Gram-negative bacteria (MDR-GNB). However, the appropriate dose is uncertain owing to the lack of pharmacokinetics data. In this study, we aimed to characterize the pharmacokinetic parameters of colistin in pediatric patients, identify the factors influencing the pharmacokinetic parameters, and propose optimal dosage regimens. Methods: A prospective, multicenter, population pharmacokinetic (PPK) study was conducted. Serial blood samples were obtained from patients after receiving the standard colistin recommended dose of 5 mg of colistin base activity (CBA)/kg/day. Plasma colistin concentrations were measured. Data were pooled from this study …

Evaluation Of The Diagnosis And Treatment Of Asymptomatic Bacteriuria At A Community Hospital, Halie Mcmillan, Abby L. Todt Pharmd, Bcps, Sarah Ferrell Pharmd, Jamie Gaul Pharmd, Bcps

Parkview Pharmacy Department

2020 ASHP Midyear Clinical Meeting / Virtual Meeting / Poster #SP-511

Objective: To evaluate the diagnosis and treatment of asymptomatic bacteriuria (ASB) within a community hospital setting.

Assessing Duration Of Therapy Recommendations Based On Clostridium Difficile Guidelines Within The Parkview Health System, Curtis Stump Pharmd, Trent Towne Pharmd, Bcps, Aubrey Mills Pharmd

Parkview Pharmacy Department

2020 ASHP Midyear Clinical Meeting / Virtual / Poster

Objective: The objective of this study was to evaluate the appropriateness of first episode CDI treatment (non-severe and severe cases) within the Parkview health system

Evaluation Of A Pharmacy Managed Vancomycin Dosing Protocol For Critically Ill Adult Patients Requiring Continuous Renal Replacement Therapy (Crrt) At A Community Hospital, Ally Fulton, Aubrey Mills Pharmd, Abby L. Todt Pharmd, Bcps, Sarah Ferrell Pharmd, Jamie Gaul Pharmd, Bcps

Parkview Pharmacy Department

2020 ASHP Midyear Clinical Meeting / Virtual Meeting/ Poster

Objective: The purpose of this medication use evaluation (MUE) was to evaluate a pharmacy managed vancomycin dosing protocol for patients on CRRT patients in a community hospital.

Characterization Of Antibiotic Use And Culture Data In Covid-19 Pandemic Patients, Ashley Logan Pharmd, Stacy Clore Pharmd, Bcps, Alissa Keillor Pharmd

Parkview Pharmacy Department

Poster Presentation

2020 ASHP Midyear Clinical Meeting / Virtual / Poster # RP-609

Objective: The objective of this study was to identify the prevalence of bacterial, viral, or fungal coinfections and to describe the empiric antimicrobial regimens in patients with confirmed COVID-19.