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Efficacy Of Emergency Laparoscopic Appendectomy In Treating Complicated Appendicitis For Elderly Patients, Tian-Chong Wu, Qiao Lu, Zhi-Yong Huang, Xio-Hui Liang

Saudi Medical Journal

Objective: To assess the therapeutic effects of emergency laparoscopic appendectomy (LA) in treating complicated appendicitis (CA) for elderly patients (defined as age >65 years). Methods: We conducted a retrospective study of 115 elderly patients with CA who underwent surgical therapy in the Affiliated Huizhou Hospital of Sun Yat-Sun University, Huizhou, Guangdong Province, China between September 2014 and August 2016. Of these, 59 patients consented to open appendectomy (OA), and LA was performed in the other 56 patients. The perioperative and follow-up variables of the 2 groups were analyzed. Results: The operative time in the LA group was longer than the …

Renal Scar Formation And Kidney Function Following Antibiotic-Treated Murine Pyelonephritis., Patrick D. Olson, Lisa K. Mclellan, Alice Liu, Kelleigh L. Briden, Kristin M. Tiemann, Allyssa L. Daugherty, Keith A. Hruska, David A. Hunstad

Student Papers, Posters & Projects

We present a new preclinical model to study treatment, resolution and sequelae of severe ascending pyelonephritis. Urinary tract infection (UTI), primarily caused by uropathogenic Escherichia coli (UPEC), is a common disease in children. Severe pyelonephritis is the primary cause of acquired renal scarring in childhood, which may eventually lead to hypertension and chronic kidney disease in a small but important fraction of patients. Preclinical modeling of UTI utilizes almost exclusively females, which (in most mouse strains) exhibit inherent resistance to severe ascending kidney infection; consequently, no existing preclinical model has assessed the consequences of recovery from pyelonephritis following antibiotic treatment. …

The Impact Of Clinical Pharmacists In Improving Jordanian Patients’ Health Outcomes, Eman A. Hammad, Rajaa A. Qudah, Amal A. Akour

Saudi Medical Journal

Objectives: To assess the impacts of clinical pharmacists on Jordanian patients’ health outcomes. Methods: A systematic review was conducted until July 2016 within EBSCO, Pubmed, Cochrane database, and ISI Web of Knowledge. Published studies evaluating the benefit of clinical pharmacy services on therapeutic, safety, humanistic, and economic outcomes in hospital or community settings in Jordan were targeted. Two reviewers independently extracted and assessed risk of bias using a pre-published validated tool. The literature search identified 130 publications of which 21 full texts met predetermined inclusion criteria. Results: Studies were of moderate quality. Pharmacist interventions resulted in an average reduction (95% …

Effectiveness Of Composting As A Biosecure Disposal Method For Porcine Epidemic Diarrhea Virus (Pedv)-Infected Pig Carcasses, Sarah Vitosh-Sillman, John Dustin Loy, Bruce Brodersen, Clayton Kelling, Kent M. Eskridge, Amy Millmier Schmidt

School of Veterinary and Biomedical Sciences: Faculty Publications

Porcine epidemic diarrhea virus (PEDV) is an enteric disease of swine that has emerged as a worldwide threat to swine herd health and production. Substantial research has been conducted to assess viability of the virus on surfaces of vehicles and equipment, in feed and water, and on production building surfaces, but little is known about the persistence in PEDV-infected carcasses and effective disposal methods thereof. This study was conducted to quantify the persistence of PEDV RNA via quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) at various time-temperature combinations and in infected piglet carcasses subjected to composting. Although this method …

Invasive Candidiasis In Pediatric Patients At King Fahad Medical City In Central Saudi Arabia: A 5-Year Retrospective Study, Zainab Almoosa, Gasmelseed Y. Ahmed, Abeer Omran, Ayah Alsarheed, Afnan Alturki, Abdulaziz Alaqeel, Mohammed Alshehri, Tariq Alfawaz, Dayel Alshahrani

Saudi Medical Journal

Objectives: To identify predisposing factors, species distribution, antifungal susceptibility, and outcome. Methods: This study is a retrospective chart review that was conducted at a children’s hospital at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. One hundred twenty-nine children with invasive candidiasis who were admitted between January 2010 and January 2015. Results: The statistical analysis results have revealed a group of risk factors; prematurity in 37 (28.7%) of patients, low birth weight in 42 (32.6%), central venous catheter in 59 (45.7%), malignancy in 21 (16.3%), immunotherapy in 20 (15.5%), and ventilator support in 60 (46.5%). More than 2-fold mortality …

Validation Of Hepa-Index As A Non-Invasive Biomarkers Panel For Assessment Of Hepatic Fibrosis In Egyptians With Chronic Hepatitis C, Mohamed Alboraie, Kerstin Schütte, Marwa Khairy, Marwa Elsharkawy, Noha Asem, Fathy Elghamry, Helmy Shalaby, Gamal Esmat, Peter Malfertheiner

Saudi Medical Journal

Objectives: To validate the diagnostic performance of Hepa-Index in predicting different stages of hepatic fibrosis in Egyptian patients with chronic hepatitis C (CHC). Methods: Hundred treatment naïve chronic hepatitis C Egyptian patients were prospectively enrolled between June 2014 and January 2015. They were subjected to: platelet count, alpha-2-macroglobulin (α2-MG), total bilirubin, gamma glutamyl transpeptidase (GGT), total cholesterol, liver biopsy and histopathological staging of hepatic fibrosis according to METAVIR scoring system. Hepa-Index was calculated according to the formula: Hepa-Index=exp (-0.021 x platelet +1.65 x α2-MG+0.2 x total bilirubin + 0.026 x GGT -1.215 x total cholesterol) / (1+exp (-0.021 x platelet …

Acquired Von Willebrand Disease Associated With Monoclonal Gammopathy Of Unknown Significance, Sijan Basnet, Catherine Lin, Rashmi Dhital, Izza Mir, Elan Mohanty, Biswaraj Tharu, Sushil Ghimire, Dilli Ram Poudel

Reading Hospital Internal Medicine Residency

We present a case of a 79-year-old male who presented with retroperitoneal hematoma a week after motor vehicle accident. Prior history and family history of bleeding were nonsignificant. His activated partial thromboplastin time was found to be prolonged in the emergency department. Further workup with coagulation studies showed decreased factor VIII, vWF antigen, and vWF:ristocetin cofactor assay, and negative Bethesda assay, indicating acquired von Willebrand disease. Immunofluorescence to find an underlying etiology was suggestive of MGUS. Management of AvWD depends on controlling active bleeding and treating the underlying cause. He was treated with factor VIII, haemate-p, rituximab, two cycles of …

High-Throughput Single-Molecule Telomere Characterization, Jennifer Mccaffrey, Eleanor Young, Katy Lassahn, Justin Sibert, Steven Pastor, Harold Riethman, Ming Xiao

School of Medical Diagnostics & Translational Sciences Publications

We have developed a novel method that enables global subtelomere and haplotype-resolved analysis of telomere lengths at the single-molecule level. An in vitro CRISPR/Cas9 RNA-directed nickase system directs the specific labeling of human (TTAGGG) n DNA tracts in genomes that have also been barcoded using a separate nickase enzyme that recognizes a 7bp motif genome-wide. High-throughput imaging and analysis of large DNA single molecules from genomes labeled in this fashion using a nanochannel array system permits mapping through subtelomere repeat element (SRE) regions to unique chromosomal DNA while simultaneously measuring the (TTAGGG) n tract length at the end of each …

Geo-Spatial Reporting For Monitoring Of Household Immunization Coverage Through Mobile Phones: Findings From A Feasibility Study, Abdul Momin Kazi, M. Ali, Ayub Khan, Hussain Kalimuddin, K. Zubair, A.N. Kazi, Azmina Artani, Syed Asad Ali

Department of Paediatrics and Child Health

Background: The addition of Global Positioning System (GPS) to a mobile phone makes it a very powerful tool for surveillance and monitoring coverage of health programs. This technology enables transfer of data directly into computer applications and cross-references to Geographic Information Systems (GIS) maps, which enhances assessment of coverage and trends.
Objective: Utilization of these systems in low and middle income countries is currently limited, particularly for immunization coverageassessments and polio vaccination campaigns. We piloted the use of this system and discussed its potential to improve the efficiency of field-based health providers and health managers for monitoring of the immunization …

Concordance Of Cerebrospinal Fluid Latex Particle Agglutination Test With Csf And Blood Culture Among Children With Acute Bacterial Meningitis, Muhammad Khalid, Ali Faisal Saleem

Department of Paediatrics and Child Health

No abstract provided.

Exploring The Role Of Competition Induced By Non-Vaccine Serotypes For Herd Protection Following Pneumococcal Vaccination, Gl Masala, M Lipsitch, C Bottomley, S Flasche

School of Engineering, Computing and Mathematics

The competitive pressure from non-vaccine serotypes may have helped pneumococcal conjugate vaccines (PCVs) to limit vaccine-type (VT) serotype prevalence. We aimed to investigate if, consequently, the indirect protection of vaccines targeting most pneumococcal serotypes could fall short of the profound effects of current formulations. We compared three previously described pneumococcal models harmonized to simulate 20 serotypes with a combined pre-vaccination prevalence in children younger than 5-years-old of 40%. We simulated vaccines of increasing valency by adding serotypes in order of their competitiveness and explored their ability to reduce VT carriage by 95% within 10 years after introduction. All models predicted …

The Influence Of Exercise Empowerment On Life Stress, Tonya M. Parker, Colleen Lewis, Christina Beaudoin

Open Access Publishing Support Funded Articles

Background: Psychological stress – when an individual perceives that the environment exceeds their ability to meet the demands placed on them - is common in college students and exercise, and specifically instructional physical activity courses, is frequently cited as a one method of stress reduction. Objective: Determine any relationship between exercise empowerment and perceived life stress for those participating in instructional physical activity courses (IPAC). Methods: All undergraduate students (n = 3388) enrolled in IPAC in 15-week IPAC at a large university were surveyed on perceived life stress (PSS), empowerment in exercise (EES), and specific demographic variables. …

Multi-Type Branching Processes Modeling Of Nosocomial Epidemics, Zeinab Mohamed, Tamer Oraby

School of Mathematical & Statistical Sciences Faculty Publications

Nosocomial epidemics are infectious diseases which spread among different types of susceptible individuals in a health-care facility. To model this type of epidemics, we use a multi-type branching process with a multivariate negative binomial offspring distribution. In particular, we estimate the basic reproduction number R0 and study its relationship with the parameters of the offspring distribution. in case of a single-type epidemic, we investigate the effect of contact tracing on the estimates for R0.

Differential Diagnosis Between The Variety Of Vasculitis Forms, Joana Hankollari, Marsida Duli, Qamil Dika, Xhenila Duli, Indrit Bimi, Daniela Dervishi

UBT International Conference

Vasculitis is an inflammation of the blood vessels. It can affect any blood vessel in the body by manifesting a variety of systemic, non-specific symptoms that make difficult the diagnosis of this pathology and especially its specific form. In front of any patient suspected of being affected by vasculitis, some questions are asked: Is the vasculitis or other pathology that camouflages, whether it is primary or secondary vasculitis, in which vessels this pathology extends, how can the diagnosis be confirmed and how can it be determined the type of vasculitis?The purpose of this study is to inform about the protocols …

The Maquiladora Experience: Employment Law Issues In Mexico, Magdeline R. Esquivel, Leoncio Lara

Law and Business Review of the Americas

No abstract provided.

Preliminary Evaluation Of An Lyta Pcr Assay For Detection Of Streptococcus Pneumoniae In Urine Specimens From Hospitalized Patients With Community-Acquired Pneumonia, Subathra Marimuthu, James T. Summersgill, Kuldeep Ghosh, Leslie A Wolf

The University of Louisville Journal of Respiratory Infections

Community acquired pneumonia (CAP) due to Streptococcus pneumoniae still occurs in at risk populations, despite the availability of effective vaccines. Laboratory confirmation of S. pneumoniae remains challenging in cases of CAP despite advances in blood culture techniques and the availability of nucleic acid amplification tests such as PCR-based methods. Urine specimens are an attractive sample type because they are non-invasive compared to bronchial washes or whole blood specimens for patients with CAP. While urine specimens have been used successfully in antigen detection assays, they have not been extensively evaluated for PCR-based assays. In this preliminary study, we evaluated the potential …

Distributing Data And Analysis Software Containers For Better Data Sharing In Clinical Research, William A. Mattingly Phd, Stephen Furmanek, Christopher M. Sinclair, Timothy L. Wiemken Phd

The University of Louisville Journal of Respiratory Infections

Introduction: Data sharing in clinical research is critical for increasing knowledge discovery. Data and software tools should be FAIR: Findable, Accessible, Inter-operable and Re-usable. Many bottlenecks exist in the process of a clinical investigator using shared data including data acquisition and statistical analysis. The objective of this project is to develop a structure for sharing data and providing rapid automated statistical analysis through creation of a pre-packaged, open-source software container.

Methods: We use the open source software container technologies VirtualBox and Vagrant to create a template for sharing clinical data and analysis scripts as a single container. We use …

Rationale And Methods Of The Study Protocol: Streptococcus Pneumoniae Serotypes In Adults 18 Years And Older With Radiographically-Confirmed Community-Acquired Pneumonia (Cap), Ronika Alexander, Paula Peyrani, Julio A. Ramirez, Wesley H. Self Md, Mph, Carlos Grijalva, Francis Counselman, Gregory A. Volturo, Heidi Kabler, Luis Ostrosky-Zeichner, Richard Wunderink, Robert L. Sherwin, Senen Pena, Thomas File, Timothy L. Wiemken, Sharon Gray, Michael Pride, Kimbal D. Ford, Qin Jiang, Raul Isturiz

The University of Louisville Journal of Respiratory Infections

This study was an active, prospective surveillance study of adults 18 years and older hospitalized with community-acquired pneumonia (CAP) due to Streptococcus pneumoniae conducted at 21 hospitals in ten cities across the United States. This report describes the surveillance methodology applied between October 7, 2013 and September 30, 2016, including the identification and description of surveillance areas and populations at-risk for CAP hospitalization for estimation of incidence rates for selected study sites.

Streptococcus Pneumoniae Antigen, Missing Opportunities Of A Promising Point Of Care Diagnostic Test, Magdelina Słomka, Ruby Gupta, Baltej Singh, Venkatesh Gondhi, Siddartha Bhandary, Ekezie Francis, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Background: The etiologic diagnosis of community acquired pneumonia (CAP) and community-acquired meningitis (CAM) are still far from optimal accuracy and turnaround time. The most common bacterial pathogen identified in both CAP and CAM is Streptococcus pneumoniae.

Methods: We reviewed the literature on S. pneumoniae antigen to highlight opportunities to optimize its use as a point of care diagnostic test to maximize quality of patient care, antimicrobial stewardship outcomes and cost saving. A PubMed search was performed using key words “S. pneumoniae antigen; rapid diagnostic tests for S. pneumoniae”. We selected articles in English and sorted into randomized …

Level Of Recall Bias Regarding Pneumococcal Vaccination History Among Adults Hospitalized With Community-Acquired Pneumonia: Results From The University Of Louisville Pneumonia Study, Sarah Van Heiden, Ruth Carrico, Timothy L. Wiemken, Ronika Alexander, John M. Mclaughlin, Qin Jiang, Paula Peyrani, William A. Mattingly, Stephen P. Furmanek, Connor L. English, Senen Pena, Raul Isturiz, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Background: Recall bias is likely to occur in vaccine effectiveness studies using self-reported vaccination history. The validity of patient-reported vaccination status for adults is not well defined. The objective of this study was to evaluate the validity of self-reported pneumococcal vaccination history among patients hospitalized with community-acquired pneumonia (CAP).

Methods: Prospective ancillary study of a population-based observational study of hospitalized patients with CAP in the city of Louisville. To be included in the analysis, patients had to (i) be reached by phone 30-days after discharge from the hospital and (ii) report that they remembered whether or not they received a …

One-Year Mortality In Patients With Community-Acquired Pneumonia, Paula Peyrani, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Pneumonia remains a common cause of morbidity and mortality in the US. Although, communityacquired pneumonia (CAP) has traditionally been considered an acute process, more recently, data have emerged showing that patients surviving an episode of CAP are at increased risk of death long after hospital discharged. In this descriptive review, we examine the current knowledge of long-term mortality and propose a hypothesis explaining the pathogenesis of long-term mortality in patients with CAP.

Skin And Fur Bacterial Diversity And Community Structure On American Southwestern Bats: Effects Of Habitat, Geography And Bat Traits, Ara S. Winter, Jennifer J.M. Hathaway, Jason C. Kimble, Debbie C. Buecher, Ernest W. Valdez, Andrea Porras-Alfaro, Jesse M. Young, Kaitlyn J.H. Read, Diana E. Northup

KIP Articles

Microorganisms that reside on and in mammals, such as bats, have the potential to influence their host’s health and to provide defenses against invading pathogens. However, we have little understanding of the skin and fur bacterial microbiota on bats, or factors that influence the structure of these communities. The southwestern United States offers excellent sites for the study of external bat bacterial microbiota due to the diversity of bat species, the variety of abiotic and biotic factors that may govern bat bacterial microbiota communities, and the lack of the newly emergent fungal disease in bats, white-nose syndrome (WNS), in the …

Most Common Statistical Methodologies In Recent Clinical Studies Of Community-Acquired Pneumonia, Stephen Furmanek, Connor L. English, Thomas Chandler, Timothy L. Wiemken Phd

The University of Louisville Journal of Respiratory Infections

Background: Training new individuals in pneumonia research is imperative to produce a new generation of clinical investigators with the expertise necessary to fill gaps in knowledge. Clinical investigators are often intimidated by their unfamiliarity with statistics. The objective of this study is to define the most common statistical methodologies in recent clinical studies of CAP to inform teaching approaches in the field.

Methods: Articles met inclusion criteria if they were clinical research with an emphasis on incidence, epidemiology, or patient outcomes, searchable via PubMed or Google Scholar, published within the timeframe of January 1st 2012 to August 1st 2017, …

Pneumonia Pathogenesis And The Lung Microbiome: Back To The Drawing Board, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Project Ngage: Results Of A Randomized Controlled Trial Of A Dyadic Network Support Intervention To Retain Young Black Men Who Have Sex With Men In Hiv Care, Dexter R. Voisin

Faculty Scholarship

HIV-positive young black MSM (YBMSM) experience poor outcomes along the HIV care continuum, yet few interventions have been developed expressly for YBMSM retention in care. Project nGage was a randomized controlled trial conducted across five Chicago clinics with 98 HIV-positive YBMSM aged 16–29 between 2012 and 2015. The intervention used a social network elicitation approach with index YBMSM (n = 45) to identify and recruit a support confidant (SC) to the study. Each index-SC dyad met with a social worker to improve HIV-care knowledge, activate dyadic social support, and develop a retention in care plan. Each index and SC also …

Antimicrobial Stewardship In Hospitalized Patients With Respiratory Infections: Ten-Year Experience From The Robley Rex Louisville Va Medical Center, Leslie A. Beavin, Forest W. Arnold, Paula Peyrani, Anupama Raghuram, David Newman, Ronald Smith, Carmen Sciortino, Stephen P. Furmanek, Ruth M. Carrico, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Rationale: Antibiotic stewardship has been defined as coordinated interventions designed to improve and measure the appropriate use of antibiotic agents. Respiratory infections are the most common infectious reason for hospitalization in the United States. Therefore, one could extrapolate that respiratory infections are then also the most common reason for hospital antibiotic use and possess the highest potential for hospital antibiotic misuse. The primary objective of this article was to evaluate the role of antimicrobial stewardship on improving antibiotic use for respiratory infections in hospitalized patients on intravenous (IV) antibiotics at the Robley Rex Louisville VAMC over a 10-year period.

Methods: …

Cerebrospinal Fluid And Blood Biomarkers For Neurodegenerative Dementias: An Update Of The Consensus Of The Task Force On Biological Markers In Psychiatry Of The World Federation Of Societies Of Biological Psychiatry, Piotr Lewczuk, Anne M. Fagan, Brian A. Gordon, Et Al

Open Access Publications

No abstract provided.

Recognition And Treatment Of Atrial Fibrillation Caused By Accessory Pathway In A Middle Age Patient., Abdelrahman M. Aljadi, Esam Baryun

Marshall Journal of Medicine

Atrial fibrillation (AF) management is every day healthcare practice at the emergency department, in-patient setting, and out-patient setting. It is a priority to identify and treat reversible causes of AF before committing the patient to an unnecessary lifelong medical regimen that may include antiarrhythmics and anticoagulants. We report a case of middle age patient with recurrent episodes of AF triggered by a concealed accessory pathway, he was on Rivaroxaban and Sotalol for years, then later successfully treated with catheter ablation of the accessory pathway. A 48 years old white Caucasian male with history of recurrent episodes of AF, he was …

A Coal Miner With Weakness, Fatigue, Nausea, Fever, Chills, Night Sweats And Dyspnea, Larry Nichols

Marshall Journal of Medicine

Delayed or missed diagnoses are a constant hazard in primary care. This is the case report of a 51-year-old coal miner, who presented as an ambulatory outpatient on a Friday with weakness, fatigue, nausea, fever, chills, night sweats and dyspnea. Chest x-ray on Saturday showed pneumonia and pleural effusion, while blood testing showed renal failure, but these results were not known by his physician until Monday, when he was hospitalized with severe sepsis due to fatal Austrian syndrome of pneumococcal pneumonia, endocarditis and meningitis. Analysis of the delay of diagnosis in this case suggests the possibility that a weekend effect …

Session Three: Trade And Development, Beverly Carl

Law and Business Review of the Americas

No abstract provided.