Medicine and Health Sciences Commons^™

Liver Injury From Medications Used For Treating Inflammatory Bowel Disease: The Drug-Induced Liver Injury Network Experience, Harish Gopalakrishna, Jiezhun Gu, Yi-Ju Li, Huiman Barnhart, Dina Halegoua-De Marzio, Herbert L. Bonkovsky, A. Sidney Barritt, Jean P. Molleston, Naga P. Chalasani, Marwan Ghabril

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: We aimed to investigate and characterise DILI due to approved therapies for inflammatory bowel disease (IBD).

METHODS: Using the Drug-Induced Liver Injury Network (DILIN) prospective study, we evaluated definite, highly likely, or probable DILI attributed to IBD therapies, including use for non-IBD indications (but excluding corticosteroids). HLA allele associations were investigated.

RESULTS: Among 1806 participants, 81 (4.5%) had IBD-agent DILI: 31 biologics (27 infliximab), 35 immunomodulators (31 azathioprine/mercaptopurine), 14 aminosalicylates (11 sulfasalazine) and 1 small molecule (tofacitinib). Median age was 45 years with 75% female and 78% White. Patients with biologic-DILI were younger, had longer latency (median 124 days), …

Evaluating Outcomes Of Alternative Pathologic Terminology In High-Grade Dysplastic Colorectal Lesions, Shaman Dalal, Aakash Desai, Nahel Tunio, Jacqueline Khalil, Devereaux Sellers, Marc Landsman

Division of Gastroenterology and Hepatology Faculty Papers

Background Pathologists occasionally classify colorectal adenomas with dysplastic mucosal invasion as intramucosal carcinoma (IMC), or carcinoma in situ (CIS), instead of high-grade dysplasia (HGD), potentially leading to earlier surveillance colonoscopies and inappropriate surgical referrals. We aimed to analyze differences in the management of patients with these diagnoses, and examined the factors that may lead to inappropriate early interval (IEI) follow-up recommendations for surveillance.

Methods We reviewed 870 colonoscopy and pathology reports from 2015-2022, excluding cases of colorectal cancer, inflammatory bowel disease, and lesions not amenable to endoscopic resection. Surveillance appropriateness was defined in accordance with the 2020 US Multi Society …

A Multi-Country Community Of Practice To Strengthen Quality Improvement In Low- And Middle-Income Countries: A Quality Improvement Program Description, Samhita Bhargava, Heather A Haq, Brodus A Franklin, Elizabeth Davis, Florence Anabwani-Richter, Thobile Bhembe, Lindokuhle P Dlamini, Makhosazana Dlamini, Andy Chapola, Nomsa Kafumba, Chisomo Mzandu Zinyemba, Menard Bvumbwe, Kyakuwa Richard Jjuuko, Jacqueline Balungi Kanywa, Dithan Kiragga, Andreas Boy Isaac, Esther Makhalanyane, Lwamba Nyembo, Retselisitoe Mahlaha, John T Farirai, Eunice W Ketang'enyi, Andrea E M Imsen, Iuliana Costas, Susan B Torrey

Faculty, Staff and Students Publications

Background/objectives: Quality improvement (QI) is widely used in global health to improve patient outcomes, reduce costs, and strengthen service delivery. The Texas Children's Global Health Network (TCGHN) includes nine independent non-governmental organizations supporting healthcare in low- and middle-income countries (LMICs), with pediatric HIV clinical centers of excellence in six countries in sub-Saharan Africa (SSA), supported technically by Baylor College of Medicine. We describe the development of a virtual QI Community of Practice (QICoP) to connect geographically dispersed teams and strengthen local QI capacity.

Methods: In 2022, QI and global health experts convened to design the QICoP and assess site readiness. …

New Applications Of Cardiopulmonary Exercise Testing Parameters Characterize Age-Related Changes In Exercise Performance During Adolescence, Katerina Kourpas, Takeshi Tsuda

Department of Pediatrics Faculty Papers

BACKGROUND: Age-related changes in exercise performance during adolescence are complex because of progressive physical and functional changes, in which multiple factors are involved.

METHODS: Peak and submaximal cardiopulmonary exercise testing (CPET) parameters were studied in healthy children and adolescents.

RESULTS: TTotal 303 subjects were divided into six groups by ages and sex: ≤11 years old (yo) (28/22 for males/females), 12–15 yo (61/98), and ≥16 yo (52/42). Rest and peak heart rate (HR) were comparable in all groups. Absolute peak values of oxygen consumption (˙ VO2), work rate (WR), and oxygen pulse (OP) were higher in older age groups in both …

Agreement Among Experienced Physical Therapist Clinicians In Naming Nystagmus: A Mixed-Methods Study Design, Lori Ann Leineke, Alessandra N. Garcia, Bridget Eubanks

Internet Journal of Allied Health Sciences and Practice

Purpose: Labeling nystagmus requires clinicians to consider multiple aspects of its presentation. The extent to which physical therapists (PTs) use consistent terminology for describing nystagmus is unknown. Recommendations for proper terminology exist, but adherence during clinical assessment has not been determined. This study investigated whether PTs with advanced vestibular rehabilitation skills and training consistently use standardized vocabulary to describe nystagmus patterns. Methods: This descriptive, cross-sectional, mixed-methods study utilized an online survey methodology, which included eight free-response questions. Participants viewed videos of nystagmus through Infrared or Frenzel goggles and documented their observations. A codebook of responses was created for each question, …

Precision Nutrition In Breast Cancer: Towards Patient- And Tumour-Informed Dietary Strategies, Cristina Crespo-García, R. Taaffe, Carolyn Peddle-Mcintyre, Emily Jeffery, John P. Campbell, Robert Thomas, Daniel A. Galvao, Robert U. Newton

Research outputs 2022 to 2026

Dietary strategies are increasingly recognized as important modulators of breast cancer outcomes, acting through effects on metabolic regulation, weight management, hormone signalling, immune function, and the gut microbiome. However, breast cancer heterogeneity and inter-individual variability mean that generic dietary guidelines may not fully capture patient needs. Precision nutrition offers the opportunity to align dietary interventions with tumour subtype, treatment context, and host biology, potentially enhancing therapeutic response and survivorship in patients diagnosed with breast cancer. In this narrative review, we summarize evidence on dietary patterns and prognosis, and explore how targeted interventions, including fasting regimens, ketogenic diets, and caloric restriction, …

The Effect Of Vigorous Physical Activity On The Incidence Of Kidney Cancer, Lawrence H. Kim, Bang, Daniel Galvao, David P. Smith, Manish I. Patel

Research outputs 2022 to 2026

Background: Kidney cancer incidence is increasing. While physical activity can reduce the risk of several cancers, the role of vigorous physical activity (VPA) in kidney cancer prevention remains unclear. We examined associations between physical activity intensity and kidney cancer incidence in a large Australian cohort. Methods: Data were obtained from 267,357 adults aged ≥ 45 years in the New South Wales 45 and Up Study. Physical activity, including walking, moderate physical activity (MPA), and VPA, was self-reported at baseline using the validated Active Australia Survey and categorised according to WHO guidelines. Multivariable Cox proportional hazards models estimated hazard ratios and …

The Interplay Between Osteosarcopenia And Intrinsic Capacity: Insights And Associations With All-Cause Mortality In The Toledo Study For Healthy Aging, Ivan Baltasar-Fernandez, Pedro L. Valenzuela, Irene Rodríguez-Gómez, Fabio Quiñonez-Bareiro, Luis M. Alegre, Konstantinos Prokopidis, Leocadio Rodriguez-Mañas, Ignacio Ara, Oscar Rosas-Carrasco, Lana J. Williams, Robinson Ramirez-Vélez, Julie A. Pasco, Guy Hajj-Boutros, Raman Agnihotram, Marc Sim, Wayne Lok Ok Choo, Mahdi Imani, Ana M. Ayala-Copete, Julia Chabot, Miguel G. Borda, Nailton J. Neto, Claire Godard-Sebillotte, Howard Bergman, Anna Andrianova, Hidenori Arai, Pierrette Gaudreau

Research outputs 2022 to 2026

Background: Osteosarcopenia—the coexistence of osteopenia/osteoporosis and sarcopenia—is associated with numerous adverse health outcomes, but its association with intrinsic capacity (IC) remains unknown. We aimed to explore the associations of osteosarcopenia with IC and all-cause mortality in older adults. Methods: We conducted a cross-sectional analysis of IC and a prospective analysis of all-cause mortality in 1142 participants from the Toledo Study for Healthy Aging (75.1 ± 6.0 years, 53.1% women). Participants were classified as having no musculoskeletal disorders, osteopenia/osteoporosis, sarcopenia, or osteosarcopenia (DXA- and EWGSOP2-based criteria). IC was operationalized as a composite score integrating locomotion, cognition, psychological, vitality, and sensory domains. …

Social Relationships, Mental Health, And Stigma: A Qualitative Study Of Social Networks And Hiv Disclosure In Western Kenya, Sarah Obatsa, Adel Mburia-Mwalili, Salvador Jauregui, Karla Wagner, Lukoye Atwoli, Francesca Odhiambo, Jayne Lewis-Kulzer, Suzanne Goodrich, Kara Wools-Kaloustian, Jennifer Syvertsen

Internal Medicine, East Africa

The disclosure of one’s HIV-positive status is a personal decision that can play an important role in engagement in HIV treatment and care. Social network approaches situate individuals within broader webs of social connections that influence health and wellbeing and thus hold the potential to elucidate key social factors shaping the process of disclosure. As part of a larger clinical study examining how substance use and mental health shape HIV outcomes, we recruited 61 individuals newly diagnosed with HIV at two clinics in Western Kenya to participate in an egocentric social networks study. We conducted a survey that generated a …

Hydroxyurea Interferes With Point-Of-Care Creatinine Testing In Children With Sickle Cell Anemia, Ruth Namazzi, Robert Opoka, Charles Ssuuna, Michael Goings, Kathryn Mcelhinney, Dibyadyuti Datta, Russell Ware, Chandy John, Andrea Conroy

Paediatrics and Child Health, East Africa

Objective To evaluate the performance of the point-of-care i-STAT device for creatinine measurement in Ugandan children with sickle cell anemia (SCA), and to determine the clinical impact of hydroxyurea-associated assay interference.

Results description This secondary analysis was nested within a randomized clinical trial involving 248 Ugandan children with SCA. The mean age at enrollment was 32 months, and 115/248 (46.2%) initiated hydroxyurea during 12 months of follow-up as part of routine clinical care. At enrollment, creatinine values measured by i-STAT and reference laboratory testing were clinically comparable. At follow-up, children receiving hydroxyurea had significantly higher creatinine values measured by iSTAT …

Paracrine Signals From Hiv-1-Infected Immune Cells Reprogram Cervical Cancer Pathways, Charles Olwal, Ujjwal Rathore, Sara Makanani, Prashant Kaushal, Immy Ashley, Manisha Ummadi, Vincent Appiah, Alexandra Lindsey Zune, Sophie Blanc, Elkanah Orang'o

Obstetrics and Gynaecology, East Africa

No abstract provided.

Response To Kodali Et Al., “Hailey-Hailey Disease: A Review And An Approach To Management”, Christina Tolete, Teresa Duong, Adam Friedman, Leonardo Tjahjono

Department of Medicine Faculty Papers

No abstract provided.

Clinical Presentations Of Pemphigus Vulgaris In Patients With Skin Of Color: A Systematic Literature Review, Haya Alkiswani, Simona Alomary, Jared Boetes, Nicole J. Baker, Susan C. Taylor

SKMC Student Presentations and Publications

Background: Pemphigus vulgaris (PV) is a rare, often severe autoimmune disease affecting skin and mucous membranes. Despite the scarce literature on PV in skin of color (SOC) populations (Fitzpatrick III-VI), existing studies suggest that there are misdiagnosis, delayed treatment, and recurrence of symptoms in SOC patients with PV. Objective: This review explores the clinical presentations of PV reported in patients with SOC, diagnostic challenges and delays, treatments, and patient outcomes to allow for an improved understanding of how PV manifests clinically in darker skin. Methods: A systematic literature review was conducted using articles found in PubMed and Embase. Two independent …

Robotic-Assisted Pedicle Screw Placement Achieves High Accuracy And Narrows The Experience Gap: A Preclinical Evaluation, Anna T. Reza, Matthias Walper, Mitchell K. Ng, Paul G. Mastrokostas, Andrew S. Lee, Rafael G. Rafael, Kornelis A. Poelstra, Ratliff K. John, Rajiv K. Sethi, Michael A. Mont

Rothman Institute Papers

To assess a robotic-assisted system versus open manual techniques to: (1) compare pedicle screw accuracy between fellows and attendings with and without robotic assistance, and (2) evaluate executed versus planned trajectory fidelity relative to prior reports. Robotic-assisted spine systems aim to improve the accuracy, reproducibility, and safety of pedicle screw placement. Limited evidence compares outcomes across differing surgeon experience levels. A total of 255 thoracolumbar pedicle screws were placed in synthetic torsos simulating adult degenerative anatomy. Four surgeons (two fellows, two attendings) each placed half their screws using open fluoroscopy-guided techniques and half using a minimally invasive percutaneous approach with …

The Dermatologic Effects Of Climate Change On Skin Of Color Populations: A Comprehensive Review, Grace Ugwueke, Simona A. Alomary, Nicole J. Baker, Susan C. Taylor Md, Nada Elbuluk Md

Student Papers, Posters & Projects

Background: Climate change contributes to rising temperatures, worsening air pollution, increasing UV exposure, and more frequent extreme weather events with downstream consequences for dermatologic conditions. However, limited research has examined how these climate-related effects can impact skin of color (SOC) populations, who often face disproportionate environmental exposures and structural inequities. Objective: To summarize the dermatologic implications of climate and environmental stressors on SOC populations. Methods: A literature search of PubMed and Embase (2000-2025) identified studies assessing dermatologic outcomes related to climate change or environmental exposures. Of 1254 records screened, 133 duplicates were removed, leaving 1121 studies for evaluation. Twenty-three studies …

Understanding And Overcoming Innate And Acquired Mapk Inhibition Resistance In Anaplastic Thyroid Cancer, Peter Y F Zeng, Jalna Meens, Amir Hossein Karimi, Harrison Pan, Matthew J. Cecchini, Laura Jarycki, Sarah B. Ryan, Alice E. Dawson, Mushfiq H. Shaikh, David A. Palma

School of Medicine Publications

Anaplastic thyroid cancer (ATC) is highly lethal. Although patients with the BRAFV600E alteration respond to the type I RAF inhibitor (RAFi) dabrafenib with trametinib, most rapidly develop adaptive or acquired resistance. Here, multi-region whole-genome, high-coverage whole-exome, and single-nuclei RNA sequencing of tumors from ATC patients undergoing type I RAFi and MEKi therapy reveals that reactivation of the mitogen-activated protein kinase (MAPK) pathway, along with immunosuppressive macrophage proliferation, may underlie the development of acquired resistance. Screening of several RAFi reveals that ATC cell lines are exquisitely sensitive to the type II RAFi naporafenib, which inhibits EphA2-mediated MAPK signaling. Further, naporafenib and …

Ambulatory Blood Pressure Monitoring Phenotypes And Circadian Blood Pressure Patterns Among Adults Referred For Diagnostic Evaluation At Aga Khan University Hospital, Nairobi, Kenya: A Retrospective Cross-Sectional Study, Nadeem Kassam, Mzee Ngunga, James Orwa, Alisa Bhojani, Mohamed Varwani, Swaffiya Salim, Yvonne Oketch, Salim Surani, Anthony Ochola, Barbara Karau, Jeilan Mohamed, Etienne Amendezo

Internal Medicine, East Africa

Introduction: hypertension represents the primary modifiable risk factor for cardiovascular disease and poses a public health challenge in sub-Saharan regions, with Kenya experiencing particularly low detection and control rates. Traditional office-based blood pressure measurements often fail to detect key phenotypes, such as white-coat and masked hypertension. Ambulatory Blood Pressure Monitoring (ABPM) offers a comprehensive 24-hour profile that excludes white-coat hypertension and allows for the evaluation of circadian patterns, including nocturnal hypertension and non-dipping status, both of which are recognized as high-risk phenotypes strongly linked to adverse cardiovascular events. This study evaluated ABPM data from Aga Khan University Hospital, Nairobi …

Standardizing Nutrition Protocols For Brain Tumor Patients, Wendy Aldrich, Clifford A Pierre, Jun Ma, Mariam Ishaque, Christa Seyler, Miri Kim

All Poster Presentations

No abstract provided.

Development Of An Oncology Clinical Research Complexity And Acuity Score For Outpatient Treatment By Visit, Shannon Hoffman

All Poster Presentations

No abstract provided.

The Impact On Nurses' Knowledge And Confidence Of Simulation With Chimeric Antigen Receptor T-Cell Infusion, Rachael Crickman, Shannon Williams, Heather Bissmeyer, Frances Chu, Cara Gallegos

All Poster Presentations

No abstract provided.

Evaluating Low Molecular Weight Heparin For Venous Thromboembolism Treatment In Extreme Body Weights, Natalie Tran, Brittanii Prahl, Jordan Amaro, Barbara Branneman, Jack Huber

All Poster Presentations

No abstract provided.

Euglycemic Diabetic Ketoacidosis: Institutional Review And Protocol Development, Lim Kang, Jordan Amaro, Brittanii Prahl, Jack Huber

All Poster Presentations

No abstract provided.

A Qualitative Exploration Of Spirituality In People Living With Dyspnea And Serious Illness, Leah Mccann Klug

All Poster Presentations

No abstract provided.

Comparable Endogenous Immune Reconstitution, Car-T Expansion, And Cytokine Profiles With Bendamustine Versus Fludarabine/Cyclophosphamide Lymphodepletion, Matthew Schwede, Sarah Hawley, Zachary Reitz, Faith Kierney, Neil Bailey, Tenzin Tsomo, Laiken Lopez, Terry Gilbertson, Christopher A Carney, Doug Kieper, Kelly Paulson, Krish Patel

All Poster Presentations

No abstract provided.

Where Housing And Healthcare Meet: Ed Utilization Through On-Site Nursing And Fmr Collaboration, Bennett Gosiker, Tara Ahmadi, Bessie Liu, Naeemah Munir, Viet Nguyen, Carrie B Rubenstein

All Poster Presentations

No abstract provided.

Enhancing Lactation Support In The Icu Via Interdisciplinary Collaboration, Lexxi Ellis, Aretha Miller

All Poster Presentations

No abstract provided.

Standardizing Interprofessional Serious Illness Conversations In Inpatient Specialty Palliative Care, Leah Mccann Klug, Catherine Patterson

All Poster Presentations

No abstract provided.

Comparative Analysis Of Emergency Department Pain Medications Given For Treatment Of Sickle Cell Pain Crisis, Christo Mitchell, Kristian Campbell, Brittanii Prahl, Jack Huber

All Poster Presentations

No abstract provided.

Development And Validation Of The Lifetime Sense Of Safety Scale In Kenyan Adults, Karen Blackmon, Anne Nyambura, Anne Gitere, Levi Muyela, Catherine Onyancha, Kendi Muchungi, Catherine Ajalo, Litha Musili, Rachel Maina, Edna Bosire, Lukoye Atwoli, Zul Merali, Chinedu Momoh

Brain and Mind Institute

Background. Safety supports psychological wellbeing and potentially shapes brain aging yet existing scales overlook cumulative lifespan safety experiences.

Methods. To address this gap, we developed and validated the Lifetime Sense of Safety (LSS) scale in Kenyan adults. The LSS uses visual analog scaling with a red-to-green color gradient to retrospectively rate felt safety across life stages and settings. We evaluated scale psychometrics and associations with social determinants of health and indicators of brain health.

Results. The LSS shows adequate internal consistency and test-retest reliability, with two distinct but correlated factors representing childhood and adulthood safety. Women and …

Contextual Variability In Under-Diagnosed Cardiometabolic Disease And Cognitive Vulnerability Among Populations At High Risk For Alzheimer's Disease And Related Dementias, Nwanyieze Jiakponnah, Joseph Curran, Tamlyn Watermeyer, Jasmit Shah, Litha Musili, Stanely Onyango, Benard Aliwa, Zul Merali, Karen Blackmon, Chinedu Momoh

Brain and Mind Institute

Underdiagnosis of cardiometabolic risk factors (CMRFs) may represent an unrecognised biological pathway contributing to dementia risk; yet remains poorly characterised in African and African diaspora populations. We quantified the prevalence and determinants of underdiagnosed hypertension and abnormal glycaemia across four cohorts comprising up to 7000 adults aged ≥40 years from Nigeria, Kenya, and The United States: Indianapolis, and North Texas. Underdiagnosis was defined as absence of self-reported diagnosis despite elevated systolic blood pressure ( ≥130 mmHg) or fasting blood glucose ( ≥100 mg/dL). Cohort-stratified analyses examined demographic, socioeconomic, cognitive, Alzheimer’s genetic, and blood-based biomarker correlates. Underdiagnosis was pervasive in African …