Medicine and Health Sciences Commons^™

Unclear Source Of Gastrointestinal Bleeding: Utilizing Small Bowel Capsule To Detect An Enteric Duplication Cyst, Victoria Sarata, Kirby Lampe, Kathryn Clarkston

Posters

Introduction Enteric duplication cysts (EDCs) are rare congenital malformation formed during embryonic development of the gastrointestinal tract. Symptoms may include vomiting, abdominal distension, palpable abdominal mass, or bleeding but may vary based on location of the lesion [1]. We present a case of a 9-year-old-male with presented with recurrent rectal bleeding and had abnormalities on small bowel capsule which were diagnosed as enteric duplication cyst on exploratory laparoscopy. Case This is a 9 year old male with a history of persistent iron deficiency anemia, gallstones s/p cholecystectomy and recurrent hematochezia. Patient was initially admitted for recurrent red bloody stools and …

Symptomatic Severe Hyponatremia: A Rare Complication Of Double Balloon Enteroscopy, Victoria Sarata, Kirby Lampe, Thomas M. Attard

Posters

Previously healthy 11-year-old female, newly diagnosed Peutz-Jeghers Syndrome (PJS) confirmed by genetic testing STK11 PV (c.464+1dupG) underwent double balloon enteroscopy (DBE) after small bowel capsule showed multiple small intestinal polyps including >1.5 cms diameter. Pre-procedure, she completed a two-day MiraLAX clean out with >10 x 17g doses of MiraLAX each mixed in 6-8oz of water and other clear liquids. DBE completed with resection of 17 total small intestinal (SI), jejunal and ileal polyps. Procedure lasted approximately 4hrs and 5L of sterile water was used for underwater technique and irrigation.Sterile water was used for copious irrigation needed for direct visualization, and …

Liquid Biopsies Of Lung Cancer And Next Generation Sequencing At Sub-Saharan Africa Sites (Lungs@Africa), Nadia Ghazali, Catherine Brown, Trevor Pugh, Rayjean Hung, Kelechi Okonta, Mansoor Saleh, Shahin Sayed, Richard Khanyile, Zodwa Dlamini

Pathology, East Africa

Introduction: There is a lack of genomic and epidemiologic data regarding lung cancer in Sub-Saharan Africa. Liquid biopsy is a non-invasive and scalable approach for molecular profiling. This pilot study aims to determine the prevalence of actionable genetic alterations (AGAs) of non-small cell lung cancer (NSCLC) using liquid biopsy while establishing a liquid biopsy testing pipeline in Sub-Saharan Africa.

Methods: This is a prospective, cohort study at three sites: Aga Khan University Cancer Centre in Nairobi, Kenya; University of Port Harcourt Teaching Hospital in Port Harcourt, Nigeria; and Steve Biko Academic Hospital, University of Pretoria in Pretoria, South …

Hallucinations, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Ear Foreign Body, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Laceration, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Cerumen Impaction, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Associations Of Estrogen With Modifiable And Non-Modifiable Risk Factors For Dementia: A Narrative Review, Sarah Gregory, Katie Bridgeman, Hannah Darwin, Mariapaola Barbato, Laura Booi, Anna Serrat, Antonella Chadha, Francesca Farina, Natalie Jenkins, Beverly Cheserem

Brain and Mind Institute

Female sex is associated with higher incidence and risk of dementia. Estrogen may rep-resent one important mechanism contributing to the increase in incidence rates. In thisreview, we synthesize narratively the evidence for associations between estrogen—across the life course from menarche to menopause, estrogen-containing hormonalcontraception and hormone replacement therapies, and pregnancy—with potentialmodifiable risk factors for dementia. These include education, hearing loss, traumaticbrain injury, hypertension, alcohol use, obesity, smoking, depression, physical inactiv-ity, diabetes, low-density lipoprotein (LDL) cholesterol, social isolation, air pollution,and untreated visual loss, as well as apolipoprotein E ε4. In addition, evidence is sum-marized for associations with sleep, diet, and stress. …

Age-Specific Distribution Of Cervical Precancer And Cancer Among Women Living With Hiv Across Seven Countries: A Systematic Review And An Individual Patient Data Meta-Analysis, Shona Dalal, Karin Sundström, Ronaldo Silva, Katayoun Taghavi, Helen Cejtin, Michael Chung, Sharon Greene, Smita Joshi, Helen Kelly, Elkanah Orang'o

Obstetrics and Gynaecology, East Africa

Background Women living with HIV have an elevated risk for cervical cancer, present earlier, and have more recurrent human papillomavirus (HPV) infections compared with women without HIV. To update WHO recommendations on screening and treatment to prevent cervical cancer, we aimed to identify whether women living with HIV should be screened for cervical cancer at a specific age, the optimal screening interval following a negative cervical screen, and the screening interval following treatment.

Methods We conducted a systematic literature review on cervical cancer and HIV by searching MEDLINE, Embase, CENTRAL, the Cochrane Library, and clinical trial registries covering Jan 1, …

Placement, Duration And Re-Entry Outcomes For Children In Foster Care With Disabilities, Jill Mcleigh, Alan Huang, Rong Huang, Gunjan Singh

Health Status, Outcomes, and Literacy and Healthcare Utilization

National, longitudinal studies exploring characteristics and outcomes of children in foster care (CFC) with disabilities are lacking. This study explores the prevalence, characteristics and relative risk of experiencing placement instability, staying in care for longer than 2 years, and returning to care within 3 years for CFC with a disability and by disability type.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

The Epidemiology Of Us Upper Extremity Amputations: An Analysis Of The Global Burden Of Disease Database (1990-2019)., Ambrose Loc T Ngo, Cameron J Sabet, Gabrielle Dykhouse, Ayah Ibrahim, Taylor J Manes, Arsalaan Sayyed, Shaheryar Asad, Benjamin C Taylor

Surgery Articles

Background Upper extremity amputations (UEAs) are medically, psychologically, and functionally devastating. This study aimed to evaluate region- and sex-specific differences in unilateral and bilateral upper extremity amputations in the United States (US) from 1990 to 2019. Methods The Global Burden of Disease (GBD) database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for upper extremity amputations in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p< 0.05. Results Between 1990 and 2019, unilateral upper extremity amputations in the US showed a 34.51% decrease in YLDs, 34.34% in prevalence, and 37.38% in incidence. Bilateral amputations decreased by 51.32%, 48.94%, and 56.80%, respectively. Men consistently had higher YLDs, prevalence, and incidence rates for unilateral amputations (p< 0.001). Regionally, the Northeast had the highest mean YLDs, prevalence, and incidence, while the South had the lowest. Men also experienced significantly higher rates of both unilateral and bilateral amputations across all regions compared to women (p< 0.05). Conclusions From 1990 to 2019, the US experienced declines in YLDs, prevalence, and incidence of upper extremity amputations. Men had higher rates than women across all regions. The Northeast exhibited the highest rates, while the South had the lowest. These findings underscore notable gender and regional disparities in upper extremity amputation trends.

Correction: A Comprehensive Narrative Review Of The Challenges Surrounding Cutaneous Scc., Sarah C Beach, Austin S Cusick, Aaron S Farberg, Shannon C Trotter

Ambulatory and Primary Care Articles

No abstract provided.

Use Of Osteopathic Manipulation Techniques For Management Of Acute Otitis Media In Pediatric Patients: A Scoping Review., Cory Hyun-Su Kim, Lauren R Mccray, Shaun A Nguyen, Carl Shermetaro, Wayne K Robbins

Ambulatory and Primary Care Articles

OBJECTIVE: To map and summarize the existing literature on the use of osteopathic manipulative techniques (OMT) in the management of acute otitis media (AOM) in pediatric patients, with an emphasis on reported outcomes and identifying gaps in the current evidence.

DATA SOURCES: CINAHL, PubMed, and SCOPUS.

REVIEW METHODS: A comprehensive literature search was conducted across multiple databases following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Studies were charted and summarized based on key characteristics, including study design, population, types of OMT applied, and reported outcomes on management of AOM and recurrent AOM …

Leukoplakia: An Uncommon Presentation Of Acute Febrile Neutrophilic Dermatosis (Sweet Syndrome)., Suchita Sampath, Bryce Delong, Sahil Kapur, Matthew J Franklin

Ambulatory and Primary Care Articles

No abstract provided.

New Onset Of Comorbidities In People With Epilepsy In A National Healthcare Claims Database., Edward Faught, Emily Klatte, Clarence T Wade, Sean Stern, Wesley T Kerr

Neuroscience Articles

PURPOSE: This study evaluated the rate of new occurrence of select comorbidities in adults after events of uncontrolled epilepsy versus controlled epilepsy.

METHODS: The HealthVerity Marketplace Inovalon healthcare claims database was used. Adults (≥18 years) with an epilepsy diagnosis (ICD-10-CM G40*) prescribed at least one antiseizure medication (ASM) between January 1, 2015, and December 31, 2021, were included. Patients were categorized as having either a first-filled or third-filled ASM. The first ASM filled was defined as no ASMs filled for at least 1 year of enrollment. Uncontrolled epilepsy events within 1 year of new ASM initiation were: seizure-related inpatient or …

J. Robert Gladden Orthopaedic Society Research Grants: What Is The Return On Invesments, Lancelot Benn, Susan Stephens, Mark Ehioghae, Rishi Balkissoon, Brendan A. Williams, Shaina Lipa, David N. Bernstein, Gbolabo Sokunbi, Barrett I. Woods, Wakenda Tyler, Jaysson Brooks, Randall C. Morgan, Kwadwo Owusu-Akyaw, Wayne Johnson, Eric Carson, George V. Russell, Addisu Mesfin

Rothman Institute Papers

INTRODUCTION: The J. Robert Gladden Orthopaedic Society (JRGOS) aims to increase diversity in orthopaedic surgery and promote high-quality musculoskeletal care for all. Through targeted research funding, JRGOS supports projects aligned with its mission. Despite awarding over $300,000 in research grants since 2011, the return on investment (ROI) of this program has not been analyzed. This study evaluates the ROI of JRGOS research grants from 2011 to 2023.

METHODS: We conducted a retrospective review of all JRGOS research grants awarded between 2011 and 2023. Data included recipient demographics, grant titles, award year, institution, and amount. PubMed and Google Scholar were used …

Slimmer’S Paralysis In The Era Of Glp-1 Therapy: A Review Of Recent Cases, Nidhin John, Amayrani Sanchez, Naomie Jean

School of Podiatric Medicine - Student Research

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide and tirzepatide have transformed obesity management by producing substantial and sustained weight loss. However, rapid weight reduction has been increasingly associated with peroneal neuropathy, or “slimmer’s paralysis.” This review summarizes the pathophysiology, recent case reports, and clinical implications of this emerging complication. Slimmer’s paralysis arises indirectly through loss of protective adipose tissue around the fibular head and nutritional deficiencies, rather than direct neurotoxic effects of GLP-1 agents. Recognition is critical, as timely intervention with conservative or surgical management can restore function. Clinicians should maintain vigilance in patients undergoing rapid pharmacologic weight …

Small For Gestational Age Subgroups Have Differential Morbidity, Growth, And Neurodevelopment At Age 2: The Interbio-21st Newborn Study, Aris Papageorghiou, María Restrepo-Méndez, Rose Mcgready, Fernando Barros, Francois Nosten, Shama Munim, R. Ochieng, Rachel Craik, Hellen Barsosio, James Berkley

Paediatrics and Child Health, East Africa

BACKGROUND: Small for gestational age is a complex perinatal syndrome associated with increased neonatal morbidity, mortality, and impaired childhood growth and neurodevelopment. Current classifications rely primarily on birthweight, which does not capture the heterogeneity of the condition nor predict long-term health outcomes. Here we aim to identify and characterize distinct small for gestational age subgroups and assess their neonatal and early childhood health trajectories.

OBJECTIVE: To refine the classification of small for gestational age by identifying subgroups based on maternal, fetal, and environmental factors and evaluating their associations with neonatal morbidity, growth, and neurodevelopment at age 2.

STUDY …

The Children's Hospitals In Africa Mapping Project (Champ) Survey: Facilities, Equipment, Supplies, Infrastructure, And Capacity To Respond To Emergencies, Vinayak Bhardwaj, Lawrence Stanberry, Philip Larussa, Wilmot James, Maitry Mahida, Aimable Kanyamuhunga, Atnafu Tekleab, Augustine Omoigberale, Crispen Ngwenya, Pauline Samia

Paediatrics and Child Health, East Africa

The Children’s Hospitals in Africa Mapping Project (CHAMP) survey was developed and implemented to assess the capabilities of some of the best resourced sub-Saharan African hospitals serving children. The aim was to evaluate hospital facilities, infrastructure, equipment, supplies, services, staffing, and readiness to care for children amid public health emergencies. This report analysed a subset of survey questions that characterised the hospitals and assessed facilities, equipment, supplies, infrastructure and capacity to respond to emergencies and outbreaks. Twenty-four sites were recruited. Twenty hospitals from 15 countries completed the survey from 2018 to 2019. This portion of the CHAMP study identified issues …

Refractory Benign Esophageal Strictures Complicated By Esophageal Perforation And Treated With Serial Dilations And Stent Placement In A Pediatric Patient, Kirby Lampe, Victoria Sarata, Nadia Ibrahimi

Posters

Patient is a 2-year-old male who was originally referred to GI for failure to thrive and recurrent vomiting following feeds. Upper GI showed long-segment stricture with mid-thoracic tapering and initial EGD revealed 2mmx5cm distal esophageal stricture that was balloon dilated with serial dilations and triamcinolone injections. He presented one week after his 3rd dilation with fever, vomiting and respiratory distress and was found to have cardiac tamponade, left pleural effusion, septic shock and esophageal perforation. He was transferred to the ICU and started on broad-spectrum antibiotics, IV fluids and chest tube placement. He required intubation and vasopressors. After stabilization, esophogram …

Implementation Of The Multicountry Who Covid-19 Pregnancy Cohort Study: Challenges And Lessons Learned During The Pandemic, Maria Costa, Renato Souza, Jose Cecatti, Sami Gottlieb, Marie Delnord, Soe Soe Thwin, Ndema Habib, Marleen Temmerman, Ingrid Gichere, Beth Maina

Obstetrics and Gynaecology, East Africa

Introduction A generic research protocol was developed for a prospective cohort study to allow systematic, harmonized data collection of the impact of SARS-CoV-2 infection and vaccination during pregnancy on maternal, obstetric, and neonatal outcomes across different settings. This article describes the study conception, development, implementation, challenges, and key lessons learned within study sites across the world.

Methods The protocol was implemented in 43 facilities in 10 countries during the pandemic, involving consecutive recruitment of over 16,000 pregnant or postpartum women. We evaluated selection of study sites, ethical approvals, staff recruitment and training, recruitment and follow-up, and incorporation of new elements …

Neonatal Unit Human Resources: Coverage For Six Cadres And Trends For Staff-To-Baby Ratios In 65 Neonatal Units Implementing With Nest360 In Kenya, Malawi, Nigeria, And Tanzania, Rebecca Penzias, Eric Ohuma, Opeyemi Odedere, Olabisi Dosunmu, George Okello, Hannah Mwaniki, Robert Tillya, Vincent Ochieng, Ekran Rashid, William Macharia

Paediatrics and Child Health, East Africa

Background Implementing small and sick newborn care (SSNC) requires skilled health workers; however, there is a shortage, adversely impacting patient outcomes and health worker well-being. There are limited data and no current World Health Organization (WHO) standards for staff-to-baby ratios in neonatal units in low- and middle-income countries (LMICs) to inform policy, planning, and investment.

Methods In 65 neonatal units (36 in Malawi, 13 in Kenya, 7 in Tanzania, and 9 in Nigeria), a health facility assessment (HFA) for SSNC and government-led quality improvement (QI) processes were implemented. Staffing data were collated from baseline HFA (Sept 2019–March 2021) and mid-2023 …

Intravenous Sotalol In Pediatric Cardiac Intensive Care Patients Compared To Other Antiarrhythmics: Insights From A Multicenter Database, Rohit S. Loomba, Emily R. Backes, Juan Farias Torres, Alejandro Borquez, Lindsey Malloy-Walton, Saul Flores

Posters

Background: Sotalol is an antiarrhythmic for which an intravenous (IV) form became available in 2015. Studies suggest it is safe and effective for treating pediatric arrhythmias, with fewer effects on physiologic parameters and cardiac output than amiodarone, and it does not appear to be associated with its long-term risks. However, data in pediatric patients remains limited. This study aimed to characterize the use of intravenous sotalol in pediatric intensive care admissions and compare its use and outcomes with intravenous amiodarone and procainamide. Methods: Data were drawn from the Pediatric Health Information System across six hospitals with the highest IV sotalol …

Safety Of Spinal Anaesthesia In The East African Population: Assessment Of Spinal Cord Termination Level At And Above L2 Vertebra In Adults, David Nekyon, Sheila Waa, Samuel Gitau, David Odaba

Anaesthesiology, East Africa

Background While spinal anaesthesia is a widely used technique, failure to accurately identify the L3-L4 intervertebral space (IVS) during the procedure may expose a patient to a needlestick injury to the spinal cord.

Objectives This study aimed to determine the proportion of Conus Medullaris Terminations (CMT) at or above the L2 vertebra in a black East African population and identify any age or gender-based variations.

Methodology A prospective observational study of lumbar spine MRI was conducted on 331 patients who had no vertebral deformities or prior spine surgeries. Two radiologists assessed the CMT level by consensus, referencing the nearest vertebral …

Identifying Sex- And Gender-Specific Endocrinological, Lifestyle, Psychosocial, And Socio-Cultural Targets For Alzheimer's Disease Prevention In Africans: The Female Brain Health And Endocrine Research In Africa (Fember-Africa) Project, Chinedu Momoh, Benard Aliwa, Lukoye Atwoli, Karen Blackmon, Edna Bosire, Samuel Gitau, Harrison Kaleli, Ciru Kamanda, Linda Khakali, Rachel Maina, Peter Mativo, Sylvia Mbugua, Zul Merali, Kendi Muchungi, Anne Njogu, Douglas Nyankira, Alice Ondieki, Catherine Onyancha, Stanely Onyango, Jasmit Shah, Sheena Shah, Cynthia Smith, Dilraj Sokhi, Sheila Waa, Thomas Thesen

Brain and Mind Institute

Dementia rates are rising globally, with the burden increasing most rapidly in low- tomiddle-income countries. Despite this, research into Alzheimer’s disease and relateddementias (ADRD) among African populations remains limited, with existing modelsbased on Western cohorts that overlook sex-, gender-, and ancestry-specific factors.The Female Brain Health and Endocrine Research in Africa (FemBER-Africa) project,hosted at the Brain and Mind Institute, Aga Khan University, Kenya, will establish adeeply phenotyped cohort of 250 African individuals across the ADRD spectrum. Itwill assess sex-specific risk factors linked to ethnicity, lifestyle, and endocrinologicalvariables using fluid-based biomarkers (blood and saliva), neuroimaging (magneticresonance imaging and positron emission tomography), and …

Prevalence And Determinants Of Nomophobia Among Healthcare Workers In Nepal: A Cross-Sectional Study, Prakash Banjade, Asmita Itani, Munish Sharma, Reena Shah, Jasmit Shah, Aakansha Singh, Rahul Kashyap, Salim Surani

Brain and Mind Institute

Introduction: Nomophobia, the fear of being without a mobile phone, has become a significant concern in the current digital age. Healthcare professionals rely heavily on mobile devices for communication and information access. This cross-sectional study aimed to assess the prevalence and determinants of nomophobia among healthcare workers in Nepal.

Methods: A modified Nomophobia Questionnaire (NMP-Q) was used to determine nomophobia scores. Demographic characteristics such as age, gender, race, type of smartphone, hours spent on a smartphone, and type of medical specialty were considered to evaluate nomophobia in diverse groups of healthcare workers. Summary statistics were presented as frequencies …

Evaluating The Impact Of Alcohol On Dementia: Evidence From 13 Developing Countries, Cyprian Mostert

Brain and Mind Institute

Background: The 2024 Lancet Commission on Dementia Prevention identified alcoholconsumption as a risk factor contributing to a global increase in dementia cases by onepercent.

Method: We used a panel VAR model to analyze the impact of alcohol consumption ondementia prevalence in 13 developing countries with different alcohol tax systems.

Result: In countries with progressive alcohol tax systems, an increase in taxes onbeer and spirits leads to a 10 percent reduction in per capita alcohol consumption.This decline corresponds to a 4 percent reduction in dementia prevalence within fouryears. In countries with hybrid alcohol tax systems, a combination of alcohol bansand tax …

Assessing The Tumor Suppressive Impact And Regulatory Mechanisms Of Spdef Expression In Breast Cancer, Maansi Solanky, Maninder Khosla, Suresh K. Alahari

School of Graduate Studies Faculty Publications

Background/Objectives: Breast cancer is a heterogeneous disease, and the role of the transcription factor SPDEF remains controversial. We aimed to clarify the prognostic value of SPDEF, explore demographic and molecular correlates of its expression, and investigate potential regulatory mechanisms underlying its dysregulation. Methods: Genomic and clinical data for 1218 breast cancer tumors were obtained from The Cancer Genome Atlas (TCGA). SPDEF mRNA expression was compared across intrinsic subtypes, age, and race, and prognostic significance was evaluated by Kaplan–Meier analysis. Promoter methylation patterns and DNA methyltransferase (DNMT) expression were examined as potential regulatory drivers. Co-expression analysis was performed using gene panels …

Small For Gestational Age Subgroups Have Differential Morbidity, Growth, And Neurodevelopment At Age 2: The Interbio-21st Newborn Study, Aris T. Papageorghiou, María C. Restrepo-Ménde, Rose Mcgready, Fernando C. Barros, Francois Nosten, Shama Munim, Roseline Ochieng, Rachel Craik, Hellen C. Barsosio, Zulfiqar Ahmed Bhutta

Department of Obstetrics & Gynaecology

Background: Small for gestational age is a complex perinatal syndrome associated with increased neonatal morbidity, mortality, and impaired childhood growth and neurodevelopment. Current classifications rely primarily on birthweight, which does not capture the heterogeneity of the condition nor predict long-term health outcomes. Here we aim to identify and characterize distinct small for gestational age subgroups and assess their neonatal and early childhood health trajectories.
Objective: To refine the classification of small for gestational age by identifying subgroups based on maternal, fetal, and environmental factors and evaluating their associations with neonatal morbidity, growth, and neurodevelopment at age 2.
Study design: Prospective …

Plasma Biomarkers In Neuropsychiatric Syndromes: A Narrative Review, Zahinoor Ismail, Dylan X Guan, Ganesh Babulal, James Bateman, Marc Cantillon, Byron Creese, Fabrizia D'Antonio, Corinne Fischer, Jennifer Gatchel, Chinedu Momoh

Brain and Mind Institute

Neuropsychiatric symptoms (NPS) are common features of neurodegenerative disease (NDD) but are relatively understudied compared to cognition, especially regarding biomarkers. Further, emerging evidence describes the utility of systematic assessment of NPS across the cognitive continuum, even in advance of dementia. In this narrative review, we discuss the role of plasma biomarkers in relation to NPS across the cognitive continuum of unimpaired, subjective cognitive decline, mild cognitive impairment, and dementia. While Alzheimer's disease is the primary focus, vascular, Lewy body, and frontotemporal dementia etiologies are also discussed. Literature searches included NPS and dementia-related search terms with additional literature identified based on …