Digital Commons Network^™

Influence Of Concomitant Ablation Of Nonparoxysmal Atrial Fibrillation During Coronary Artery Bypass Grafting On Mortality And Readmissions, John A Treffalls, Katie J Hogan, Paige E Brlecic, Christopher B Sylvester, Todd K Rosengart, Joseph S Coselli, Marc R Moon, Ravi K Ghanta, Subhasis Chatterjee

Faculty, Staff and Students Publications

OBJECTIVE: We determined the utilization rate of surgical ablation (SA) during coronary artery bypass grafting (CABG) and compared outcomes between CABG with or without SA in a national cohort.

METHODS: The January 2016 to December 2018 Nationwide Readmissions Database was searched for all patients undergoing isolated CABG with preoperative persistent or chronic atrial fibrillation by using the International Classification of Diseases, 10th Revision classification. Propensity score matching and multivariate logistic regressions were performed to compare outcomes, and Cox proportional hazards model was used to assess risk factors for 1-year readmission.

RESULTS: Of 18,899 patients undergoing CABG with nonparoxysmal atrial fibrillation, …

Serum Biomarkers Of Nociceptive And Neuropathic Pain In Chronic Pancreatitis, Jami L Saloman, Yan Li, Kimberly Stello, Wenhao Li, Shuang Li, Anna Evans Phillips, Kristen Hall, Evan L Fogel, Santhi Swaroop Vege, Liang Li, Dana K Andersen, William E Fisher, Christopher E Forsmark, Phil A Hart, Stephen J Pandol, Walter G Park, Mark D Topazian, Stephen K Van Den Eeden, Jose Serrano, Darwin L Conwell, Dhiraj Yadav, Consortium For The Study Of Chronic Pancreatitis, Diabetes, And Pancreatic Cancer (Cpdpc)

Faculty, Staff and Students Publications

Debilitating abdominal pain is a common symptom affecting most patients with chronic pancreatitis (CP). There are multiple underlying mechanisms that contribute to CP-related pain, which makes successful treatment difficult. The identification of biomarkers for subtypes of pain could provide viable targets for nonopioid interventions and the development of mechanistic approaches to pain management in CP. Nineteen inflammation- and nociception-associated proteins were measured in serum collected from 358 subjects with definite CP enrolled in PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies, a prospective observational study of pancreatitis in US adult subjects. First, serum levels of putative biomarkers were …

Development Of Thermosensitive Hydrogel Of Amphotericin-B And Lactoferrin Combination-Loaded Plga-Peg-Pei Nanoparticles For Potential Eradication Of Ocular Fungal Infections, Sammar Fathy Elhabal, Shrouk A Ghaffar, Raghda Hager, Nahla A Elzohairy, Mohamed Mansour Khalifa, Passant M Mohie, Rania A Gad, Nasreen N Omar, Mohammed H Elkomy, Mohammad Ahmad Khasawneh, Nashwa Abdelaal

Faculty, Staff and Students Publications

The most prevalent conditions among ocular surgery and COVID−19 patients are fungal eye infections, which may cause inflammation and dry eye, and may cause ocular morbidity. Amphotericin-B eye drops are commonly used in the treatment of ocular fungal infections. Lactoferrin is an iron-binding glycoprotein with broad-spectrum antimicrobial activity and is used for the treatment of dry eye, conjunctivitis, and ocular inflammation. However, poor aqueous stability and excessive nasolacrimal duct draining impede these agens' efficiency. The aim of this study was to examine the effect of Amphotericin-B, as an antifungal against Candida albicans, Fusarium, and Aspergillus flavus, and Lactoferrin, …

Development Of Canagliflozin Nanocrystals Sublingual Tablets In The Presence Of Sodium Caprate Permeability Enhancer: Formulation Optimization, Characterization, Sammar Fathy Elhabal, Mohamed A El-Nabarawi, Nashwa Abdelaal, Mohamed Fathi Mohamed Elrefai, Shrouk A Ghaffar, Mohamed Mansour Khalifa, Passant M Mohie, Dania S Waggas, Ahmed Mohsen Elsaid Hamdan, Samar Zuhair Alshawwa, Essa M Saied, Nahla A Elzohairy, Tayseer Elnawawy, Rania A Gad, Nehal Elfar, Hanaa Mohammed, Mohammad Ahmad Khasawneh

Faculty, Staff and Students Publications

Canagliflozin (CFZ) is a sodium-glucose cotransporter-2 inhibitor (SGLT2) that lowers albuminuria in type-2 diabetic patients, cardiovascular, kidney, and liver disease. CFZ is classified as class IV in the Biopharmaceutical Classification System (BCS) and is characterized by low permeability, solubility, and bioavailability, most likely attributed to hepatic first-pass metabolism. Nanocrystal-based sublingual formulations were developed in the presence of sodium caprate, as a wetting agent, and as a permeability enhancer. This formulation is suitable for children and adults and could enhance solubility, permeability, and avoid enterohepatic circulation due to absorption through the sublingual mucosa. In the present study, formulations containing various surfactants …

Safety Of Prehospital Intravenous Bolus Dose Nitroglycerin In Patients With Acute Pulmonary Edema: A 4-Year Review, Casey Patrick, Louis Fornage, Brad Ward, Michael Wells, Kevin Crocker, Kelly Rogers Keene, Sara Andrabi, Robert Dickson

Faculty, Staff and Students Publications

Background: Intravenous nitrates are a primary therapy for hypertensive congestive heart failure (CHF) with acute pulmonary edema (APE) in the hospital setting. Historically, sublingual nitrates are the mainstay of emergency medical services (EMS) pharmacologic therapy for these patients. We aimed to evaluate the safety of prehospital bolus dose intravenous nitroglycerin in patients with APE.

Methods: This is a retrospective evaluation of EMS data between March 15, 2018, and March 15, 2022, where CHF with APE was suspected and bolus-dose intravenous nitroglycerin was administered. Protocol inclusion criteria were hypertension (systolic blood pressure [SBP] >160 mmHg) and acute respiratory distress, with a …

Qt Interval And Short-Term Outcome In Acute Heart Failure, Òscar Miró, Oriol Aguiló, Joan Carles Trullàs, Víctor Gil, Begoña Espinosa, Javier Jacob, Pablo Herrero-Puente, Josep Tost, María Luísa López-Grima, Pere Comas, Carlos Bibiano, Lluís Llauger, Enrique Martin Mojarro, María Pilar López-Díez, Julio Núñez, Zubaid Rafique, Kelly R Keene, Frank Peacock, Pedro Lopez-Ayala, Christian Mueller, Manuel Montero Pérez-Barquero, Lluís Mont, Pere Llorens

Faculty, Staff and Students Publications

Objective: To investigate the association of corrected QT (QTc) interval duration and short-term outcomes in patients with acute heart failure (AHF).

Methods: We analyzed AHF patients enrolled in 11 Spanish emergency departments (ED) for whom an ECG with QTc measurement was available. Patients with pace-maker rhythm were excluded. Primary outcome was 30-day all-cause mortality and secondary outcomes were need of hospitalization, in-hospital mortality and prolonged hospitalization (> 7 days). Association between QTc and outcomes was explored by restricted cubic spline (RCS) curves. Results were expressed as odds ratios (OR) and 95%CI adjusted by patients baseline and decompensation characteristics, using a …

Junctional Ectopic Tachycardia Caused By Junctophilin-2 Expression Silencing Is Selectively Sensitive To Ryanodine Receptor Blockade, Qixin Yang, Hanna J Tadros, Bo Sun, Minu-Tshyeto Bidzimou, Jordan E Ezekian, Feng Li, Andreas Ludwig, Xander H T Wehrens, Andrew P Landstrom

Faculty, Staff and Students Publications

Junctional ectopic tachycardia (JET) is a potentially fatal cardiac arrhythmia. Hcn4:shJph2 mice serve as a model of nodal arrhythmias driven by ryanodine type 2 receptor (RyR2)–mediated Ca2+ leak. EL20 is a small molecule that blocks RyR2 Ca2+ leak. In a novel in vivo model of JET, Hcn4:shJph2 mice demonstrated rapid conversion of JET to sinus rhythm with infusion of EL20. Primary atrioventricular nodal cells demonstrated increased Ca2+ transient oscillation frequency and increased RyR2-mediated stored Ca2+ leak which was normalized by EL20. EL20 was found to be rapidly degraded in mouse and human plasma, making it a potential novel therapy for …

Challenges In The Management Of The Kidney Allograft: From Decline To Failure: Conclusions From A Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference, Michelle A Josephson, Yolanda Becker, Klemens Budde, Bertram L Kasiske, Bryce A Kiberd, Alexandre Loupy, Jolanta Małyszko, Roslyn B Mannon, Burkhard Tönshoff, Michael Cheung, Michel Jadoul, Wolfgang C Winkelmayer, Martin Zeier, For Conference Participants

Faculty, Staff and Students Publications

In March 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a virtual Controversies Conference to address the important but rarely examined phase during which the kidney transplant is failing or has failed. In addition to discussing the definition of a failing allograft, 4 broad areas were considered in the context of a declining functioning graft: prognosis and kidney failure trajectory; immunosuppression strategies; management of medical and psychological complications, and patient factors; and choice of kidney replacement therapy or supportive care following graft loss. Identifying and paying special attention to individuals with failing allografts was felt to be important in order …

Longitudinal Magnetic Resonance Imaging-Based Superficial Femoral Artery Velocity Measurements In Diabetic And Nondiabetic Patients With Peripheral Artery Disease, Ankita Sinharoy, Neeti Reddy, John Kent Lin, Vijay Nambi, Eric Y Yang, Panagiotis Kougias, Addison A Taylor, Alan B Lumsden, Christie M Ballantyne, Gerd Brunner

Faculty, Staff and Students Publications

Background: Longitudinal associations of noninvasive 2-dimensional phase-contrast magnetic resonance imaging (2D-PC-MRI) velocity markers of the superficial femoral artery (SFA) were analyzed along with the characteristics of peripheral artery disease (PAD). We hypothesized that the 2-year differences in MRI-based measures of SFA velocity were associated with longitudinal changes in markers of PAD.

Methods: A total of 33 (11 diabetic, 22 nondiabetic) patients with PAD with baseline and 2-year follow-up MRI scans were included in this secondary analysis of the Effect of Lipid Modification on Peripheral Artery Disease after Endovascular Intervention Trial (ELIMIT). Electrocardiographically gated 2D-PC-MRI was performed at a proximal and …

Dynamic And Functional Linkage Between Von Willebrand Factor And Adamts-13 With Aging: An Atherosclerosis Risk In Community Study, Wei Liu, Kavita Patel, Yi Wang, Michael Nodzenski, Ashley Nguyen, Gayle Teramura, Harrison A Higgins, Ron C Hoogeveen, David Couper, Xiaoyun Fu, Barbara A Konkle, Matthew Shane Loop, Jing-Fei Dong

Faculty, Staff and Students Publications

Background: von Willebrand factor (VWF) is a multimeric glycoprotein critically involved in hemostasis, thrombosis, and inflammation. VWF function is regulated by its antigen levels, multimeric structures, and the state of enzymatic cleavage. Population studies in the past have focused almost exclusively on VWF antigen levels in cross-sectional study designs.

Objective: To identify subjects in the Atherosclerosis Risk in Community study who had persistently low and high VWF antigen over 10 years and to quantify longitudinal changes in the biological activities and cleavage of VWF in these subjects.

Methods: We measured VWF antigen, propeptide, adhesive activities, and cleavage by ADAMTS-13 quantified …

Global Cardiovascular Research: Gaps And Opportunities, Maha Inam, Zainab Samad, Elizabeth M Vaughan, Aysha Almas, Bashir Hanif, Abdul Mannan Minhas, Zeerak Jarrar, Fatima Zohra Habib, Sana Sheikh, Dongshan Zhu, Salim S Virani

Faculty, Staff and Students Publications

Purpose of review: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. CVDs contribute to a large health and economic burden on a global scale. We aim to describe the current landscape of global cardiovascular research, highlight significant findings, and identify potential opportunities for further studies.

Recent findings: There has been remarkable research output regarding cardiovascular health in recent decades. Large-scale collaborative studies have made impactful strides in identifying modifiable risk factors and forming evidence-based guidelines to facilitate improved cardiovascular care and outcomes. However, there are significant CVD disparities between high- and low- income countries which require …

Closing The Gaps In Care Of Dyslipidemia: Revolutionizing Management With Digital Health And Innovative Care Models, Samuel J Apple, Rachel Clark, Jonathan Daich, Macarena Lopez Gonzalez, Robert J Ostfeld, Peter P Toth, Vera Bittner, Seth S Martin, Jamal S Rana, Khurram Nasir, Michael D Shapiro, Salim S Virani, Leandro Slipczuk

Faculty, Staff and Students Publications

Although great progress has been made in the diagnostic and treatment options for dyslipidemias, unawareness, underdiagnosis and undertreatment of these disorders remain a significant global health concern. Growth in digital applications and newer models of care provide novel tools to improve the management of chronic conditions such as dyslipidemia. In this review, we discuss the evolving landscape of lipid management in the 21st century, current treatment gaps and possible solutions through digital health and new models of care. Our discussion begins with the history and development of value-based care and the national establishment of quality metrics for various chronic conditions. …

Management Of Adults With Anomalous Aortic Origin Of The Coronary Arteries: State-Of-The-Art Review, Mario Gaudino, Antonino Di Franco, Eloisa Arbustini, Emile Bacha, Eric R Bates, Duke E Cameron, Davide Cao, Tirone E David, Ruggero De Paulis, Ismail El-Hamamsy, Kanwal M Farooqi, Leonard N Girardi, Christoph Gräni, Jonathan D Kochav, Silvana Molossi, John D Puskas, Sunil V Rao, Sigrid Sandner, James Tatoulis, Quynh A Truong, Jonathan W Weinsaft, Daniel Zimpfer, Carlos M Mery

Faculty, Staff and Students Publications

As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used. In this paper, a multidisciplinary group of clinical and interventional cardiologists and cardiac surgeons performed a …

Temporary Ventricular Assist Device Support With A Catheter-Based Axial Pump: Changing The Paradigm At A Pediatric Heart Center, Sebastian C Tume, Andres A Fuentes-Baldemar, Marc Anders, Joseph A Spinner, Hari Tunuguntla, Michiaki Imamura, Asma Razavi, Edward Hickey, Gary Stapleton, Athar M Qureshi, Iki Adachi

Faculty, Staff and Students Publications

Objective: We report the largest pediatric single-center experience with an Impella (Abiomed Inc) catheter-based axial pump support.

Methods: We conducted a retrospective cohort study of all patients with acute decompensated heart failure or cardiogenic shock requiring catheter-based axial pump support between October 2014 and February 2022. The primary outcome per individual encounter (hospital admission) was defined as bridge-to-recovery, bridge-to-durable ventricular assist device support, bridge-to-cardiac transplantation, or death at 6 months after catheter-based axial pump explantation. Adverse events were defined according to the Pediatric Interagency Registry for Mechanical Circulatory Support criteria.

Results: Our final study cohort included 37 encounters with 43 …

Prevention, Diagnosis, Evaluation, And Treatment Of Hepatitis C In Chronic Kidney Disease: Synopsis Of The Kidney Disease: Improving Global Outcomes 2022 Clinical Practice Guideline, Ahmed Arslan Yousuf Awan, Marina C Berenguer, Annette Bruchfeld, Fabrizio Fabrizi, David S Goldberg, Jidong Jia, Nassim Kamar, Rosmawati Mohamed, Mário Guimarães Pessôa, Stanislas Pol, Meghan E Sise, Ethan M Balk, Craig E Gordon, Gaelen Adam, Michael Cheung, Amy Earley, Paul Martin, Michel Jadoul

Faculty, Staff and Students Publications

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2022 clinical practice guideline on prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease (CKD) is an update of the 2018 guideline from KDIGO.

Methods: The KDIGO Work Group (WG) updated the guideline, which included reviewing and grading new evidence that was identified and summarized. As in the previous guideline, the WG used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of recommendations and used expert judgment to develop recommendations. New evidence led to updating of recommendations in the chapters …

Providers’ Perspectives On The Impact Of Culture In The Recognition And Diagnosis Of Anxiety, Darius B Dawson, Christie G-J Tsao, Patricia Chen, Traber D Giardina, Terri L Fletcher

Faculty, Staff and Students Publications

Objectives: We examined providers' perspectives about how culture affects diagnosing and recognizing anxiety.

Methods: We interviewed providers about diagnosing anxiety ("How do you think culture impacts expression and diagnosis of anxiety?") and used inductive analysis, with open coding, to allow themes to emerge organically.

Results: We identified three themes: (1) Impartiality toward Culture: downplaying culture in recognizing or diagnosing anxiety and not acknowledging necessary cultural diagnostic considerations; (2) Acknowledgment of Cultural Impact: detailed variations across different cultural communities in how patients present with and describe anxiety, with differing levels of stigma associated with expressing and treating anxiety; (3) Culturally Integrated …

Blood Test Result Communication In Primary Care: Mixed-Methods Systematic Review Protocol, Helen Nankervis, Alyson Huntley, Penny Whiting, William Hamilton, Hardeep Singh, Sarah Dawson, Jane Sprackman, Anna Ferguson Montague, Jessica Watson

Faculty, Staff and Students Publications

Background: After testing, ensuring test results are communicated and actioned is important for patient safety, with failure or delay in diagnosis the most common cause of malpractice claims in primary care worldwide. Identifying interventions to improve test communication from the decision to test through to sharing of results has important implications for patient safety, GP workload, and patient engagement.

Aim: To assess the factors around communication of blood test results between primary care providers (for example GPs, nurses, reception staff) and their patients and carers.

Design & setting: A mixed methods systematic review including primary studies involving communication of blood …

Effectiveness Of A Community-Based Approach For The Investigation And Management Of Children With Household Tuberculosis Contact In Cameroon And Uganda: A Cluster-Randomised Trial, Maryline Bonnet, Anca Vasiliu, Boris K Tchounga, Benjamin Cuer, Katherine Fielding, Bob Ssekyanzi, Boris Tchakounte Youngui, Jennifer Cohn, Peter J Dodd, Georges Tiendrebeogo, Patrice Tchendjou, Leonie Simo, Richard F Okello, Albert Kuate Kuate, Stavia Turyahabwe, Daniel Atwine, Stephen M Graham, Martina Casenghi, Contact Study Group

Faculty, Staff and Students Publications

Background: Globally, the uptake of tuberculosis-preventive treatment (TPT) among children with household tuberculosis contact remains low, partly due to the necessity of bringing children to health facilities for investigations. This study aimed to evaluate the effect on TPT initiation and completion of community-based approaches to tuberculosis contact investigations in Cameroon and Uganda.

Methods: We did a parallel, cluster-randomised, controlled trial across 20 clusters (consisting of 25 district hospitals and primary health centres) in Cameroon and Uganda, which were randomised (1:1) to receive a community-based approach (intervention group) or standard-of-care facility-based approach to contact screening and management (control group). The community-based …

The 2023 Model Core Content Of Disaster Medicine, Bryan J Wexler, Carl Schultz, Paul D Biddinger, Gregory Ciottone, Angela Cornelius, Robert Fuller, Roxanna Lefort, Andrew Milsten, James Phillips, Ira Nemeth

Faculty, Staff and Students Publications

Introduction: Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners operate in situations where resources are not adequate, necessitating a modification in practice. While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States.

Study objective: The objective …

Steroid Receptor Coactivator-2 Drives Epithelial Reprogramming That Enables Murine Embryo Implantation, Vineet K Maurya, Maria M Szwarc, David M Lonard, Ramakrishna Kommagani, San Pin Wu, Bert W O'Malley, Francesco J Demayo, John P Lydon

Faculty, Staff and Students Publications

Although we have shown that steroid receptor coactivator-2 (SRC-2), a member of the p160/SRC family of transcriptional coregulators, is essential for decidualization of both human and murine endometrial stromal cells, SRC-2’s role in the earlier stages of the implantation process have not been adequately addressed. Using a conditional SRC-2 knockout mouse (SRC-2 ^d/d) in timed natural pregnancy studies, we show that endometrial SRC-2 is required for embryo attachment and adherence to the luminal epithelium. Implantation failure is associated with the persistent expression of Mucin 1 and E-cadherin on the apical surface and basolateral adherens junctions of the SRC-2 …

Tumor-Infiltrating Normal B Cells Revealed By Immunoglobulin Repertoire Clonotype Analysis Are Highly Prognostic And Crucial For Antitumor Immune Responses In Dlbcl, Zijun Y Xu-Monette, Yong Li, Thomas Snyder, Tiantian Yu, Tingxun Lu, Alexandar Tzankov, Carlo Visco, Govind Bhagat, Wenbin Qian, Karen Dybkaer, April Chiu, Wayne Tam, Youli Zu, Eric D Hsi, Fredrick B Hagemeister, Yingjun Wang, Heounjeong Go, Maurilio Ponzoni, Andrés J M Ferreri, Michael B Møller, Benjamin M Parsons, Xiangshan Fan, J Han Van Krieken, Miguel A Piris, Jane N Winter, Qingyan Au, Ilan Kirsch, Mingzhi Zhang, John Shaughnessy, Bing Xu, Ken H Young

Faculty, Staff and Students Publications

PURPOSE: Tumor-infiltrating B lymphocytes (TIL-B) have demonstrated prognostic and predictive significance in solid cancers. In this study, we aimed to distinguish TIL-Bs from malignant B-cells in diffuse large B-cell lymphoma (DLBCL) and determine the clinical and biological significance.

EXPERIMENTAL DESIGN: A total of 269 patients with de novo DLBCL from the International DLBCL R-CHOP Consortium Program were studied. Ultra-deep sequencing of the immunoglobulin genes was performed to determine B-cell clonotypes. The frequencies and numbers of TIL-B clonotypes in individual repertoires were correlated with patient survival, gene expression profiling (GEP) data, and frequencies of DLBCL-infiltrating immune cells quantified by fluorescent multiplex …

Feasibility Of Pevonedistat Combined With Azacitidine, Fludarabine, Cytarabine In Pediatric Relapsed/Refractory Aml: Results From Cog Advl1712, Katherine Tarlock, Xiaowei Liu, Charles G Minard, Emasenyie A Isikwei, Joel M Reid, Terzah M Horton, Elizabeth Fox, Brenda J Weigel, Todd Cooper

Faculty, Staff and Students Publications

Background:

Outcomes for children with relapsed/refractory (R/R) acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) are poor and new therapies are needed. Pevonedistat is an inhibitor of the NEDD-8 activating enzyme, a key regulator of the ubiquitin proteasome system that is responsible for protein turnover, with protein degradation regulating cell growth and survival.

Procedure:

We evaluated the feasibility, toxicity, and pharmacokinetics (PK) of pevonedistat (20 mg/m² days 1, 3, 5) in combination with azacitidine, fludarabine, cytarabine (aza-FLA) in children with R/R AML and MDS (NCT03813147). Twelve patients were enrolled, median age was 13 years (range 1-21). Median …

Chromoblastomycosis Presenting As A Solitary Lesion In A Non-Endemic Region, Yelena Dokic, Gordana Verstovsek, Theodore Rosen

Faculty, Staff and Students Publications

Chromoblastomycosis is a neglected tropical disease typically found in endemic tropical and subtropical regions. Herein, we discuss a rare case of a 55-year-old man in Texas who presented with an exophytic papule on the forearm, diagnosed to have chromoblastomycosis by shave biopsy and subsequent histopathological analysis. Treatment options for chromoblastomycosis include long-term oral antifungal therapy with itraconazole, physical modalities such as heat therapy in conjunction with oral antifungals, and surgical interventions such as cryosurgery or surgical excision.

Differentiating Desquamating Skin Lesions: A Case Of Methotrexate Epidermal Necrosis, Sahifah Ansari, Dina H Zamil, Edgar Rodriguez, Carly Dunn, Soo Jung Kim

Faculty, Staff and Students Publications

Desquamating skin lesions are a non-specific finding that requires urgent evaluation given the life-threatening severity of one of the potential causes, Stevens-Johnson syndrome (SJS). Methotrexate toxicity, also known in its cutaneous form as methotrexate epidermal necrosis (MEN), is another entity that presents similarly to SJS and is described here in a patient with increased risk due to his age, chronic kidney disease, and increased dose of methotrexate. His diagnosis was complicated by other historical risk factors, including antibiotic use, but was eventually elucidated when he was noted to have bone marrow suppression. Given the pathophysiology of SJS, a T-cell mediated …

Critical Care Delivery Across Health Care Systems In Low-Income And Low-Middle-Income Country Settings: A Systematic Review, Emily S Bartlett, Andrew Lim, Sean Kivlehan, Lia I Losonczy, Srinivas Murthy, Richard Lowsby, Alfred Papali, Madiha Raees, Bhavna Seth, Natalie Cobb, Jason Brotherton, Enrico Dippenaar, Gaurav Nepal, Gentle S Shrestha, Shih-Chiang E Kuo, J Ryan Skrabal, Margaret Davis, Cappi Lay, Sojung Yi, Michael Jaung, Brandon Chaffay, Nana Sefa, Marc Lc Yang, P Andrew Stephens, Amir Rashed, Nicole Benzoni, Bernadett Velasco, Neill Kj Adhikari, Teri Reynolds

Faculty, Staff and Students Publications

BACKGROUND: Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature.

METHODS: A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at …

Elevating The Educational Mission Of "Full-Service" Core Facilities Through Formal Biotechnology Workshops, Emily Ricco, Stacy Nguyen, Victoria Rodriguez, Kieu Pham, Esmanur Tokcan, Sherita Love, Alana Newell, Daniel C Kraushaar

Faculty, Staff and Students Publications

Core facility laboratories are an essential part of the successful research enterprise of many universities around the world. Core facilities provide state-of-the-art instrumentation and technologies to support research of all faculty, postdocs, and students on a fee-for-service basis. Academic next-generation sequencing cores are typically "full service" facilities, and access to and training on their instrumentation is limited to core staff. To address these limitations, we provided graduate students with technical training at our core facility. We developed a 1-week noncredit-bearing workshop and recruited 6 graduate students (N = 6) as part of a pilot program. The program involved online teaching, …

Corrigendum To “Phenotypes Of Disease Severity In A Cohort Of Hospitalized Covid-19 Patients: Results From The Impacc Study” [Ebiomedicine 83 (2022) 104208], Al Ozonoff, Joanna Schaenman, Naresh Doni Jayavelu, Carly E Milliren, Carolyn S Calfee, Charles B Cairns, Monica Kraft, Lindsey R Baden, Albert C Shaw, Florian Krammer, Harm Van Bakel, Denise A Esserman, Shanshan Liu, Ana Fernandez Sesma, Viviana Simon, David A Hafler, Ruth R Montgomery, Steven H Kleinstein, Ofer Levy, Chris Bime, Elias K Haddad, David J Erle, Bali Pulendran, Kari C Nadeau, Mark M Davis, Catherine L Hough, William B Messer, Nelson I Agudelo Higuita, Jordan P Metcalf, Mark A Atkinson, Scott C Brakenridge, David Corry, Farrah Kheradmand, Lauren I R Ehrlich, Esther Melamed, Grace A Mccomsey, Rafick Sekaly, Joann Diray-Arce, Bjoern Peters, Alison D Augustine, Elaine F Reed, Matthew C Altman, Patrice M Becker, Nadine Rouphael, Impacc Study Group Members

Faculty, Staff and Students Publications

No abstract provided.

Case Sampling Vs Universal Review For Evaluating Hospital Postoperative Mortality In Us Surgical Quality Improvement Programs, Vivi W Chen, Alexis P Chidi, Tracey Rosen, Yongquan Dong, Peter A Richardson, Jennifer Kramer, David A Axelrod, Laura A Petersen, Nader N Massarweh

Faculty, Staff and Students Publications

IMPORTANCE: Representative surgical case sampling, rather than universal review, is used by US Department of Veterans Affairs (VA) and private-sector national surgical quality improvement (QI) programs to assess program performance and to inform local QI and performance improvement efforts. However, it is unclear whether case sampling is robust for identifying hospitals with safety or quality concerns.

OBJECTIVE: To evaluate whether the sampling strategy used by several national surgical QI programs provides hospitals with data that are representative of their overall quality and safety, as measured by 30-day mortality.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study was a national, hospital-level …

Predictive Algorithm For Hepatic Steatosis Detection Using Elastography Data In The Veterans Affairs Electronic Health Records, Saroja Bangaru, Ram Sundaresh, Anna Lee, Nicole Prause, Frank Hao, Tien S Dong, Monica Tincopa, George Cholankeril, Nicole E Rich, Jenna Kawamoto, Debika Bhattacharya, Steven B Han, Arpan A Patel, Magda Shaheen, Jihane N Benhammou

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Nonalcoholic fatty liver disease (NAFLD) has reached pandemic proportions. Early detection can identify at-risk patients who can be linked to hepatology care. The vibration-controlled transient elastography (VCTE) controlled attenuation parameter (CAP) is biopsy validated to diagnose hepatic steatosis (HS). We aimed to develop a novel clinical predictive algorithm for HS using the CAP score at a Veterans' Affairs hospital.

METHODS: We identified 403 patients in the Greater Los Angeles VA Healthcare System with valid VCTEs during 1/2018-6/2020. Patients with alcohol-associated liver disease, genotype 3 hepatitis C, any malignancies, or liver transplantation were excluded. Linear regression was used …

Contemporary Use Of Coronary Physiology In Cardiology, Ayman Elbadawi, Ramy Sedhom, Mohamed Ghoweba, Abdelazeem Mohamed Etewa, Waleed Kayani, Faisal Rahman

Faculty, Staff and Students Publications

Coronary angiography has a limited ability to predict the functional significance of intermediate coronary lesions. Hence, physiological assessment of coronary lesions, via fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), has been introduced to determine their functional significance. An accumulating body of evidence has consolidated the role of physiology-guided revascularization, particularly among patients with stable ischemic heart disease. The use of FFR or iFR to guide decision-making in patients with stable ischemic heart disease and intermediate coronary lesions received a class I recommendation from major societal guidelines. Nevertheless, the role of coronary physiology testing is less clear among certain …