Medicine and Health Sciences Commons^™

Liver Transplantation In 3 Cholestatic Infants With History Of Covid Exposure, Shruti Sakhuja, Kalyani R Patel, Matthew Goss, Flor M Munoz, Garrett Wortham, Megan Crawford, John A Goss, Nhu Thao Galvan

Faculty, Staff and Students Publications

The COVID-19 pandemic presents several challenges during pregnancy including thromboembolic complications, direct placental infection, transplacental transmission, and systemic hyperinflammatory state. The liver is the second most commonly affected organ in SARS-CoV-2 infection after the lungs. Mechanisms of liver injury in COVID-19 patients can include: direct viral cytopathic effect, worsening of underlying liver disease, cytokine storm, hypoxic ischemic injury, and cholangiopathy leading to persistent marked cholestasis. Here we describe 3 infants at Texas Children's Hospital with perinatal SARS-CoV-2 exposure with persistent cholestasis and histologic evidence of extrahepatic biliary obstruction suggesting underlying biliary atresia (BA) with some atypical features possibly exacerbated by …

Pulmonary Function Testing In Pediatric Allogeneic Stem Cell Transplant Recipients To Monitor For Bronchiolitis Obliterans Syndrome: A Systematic Review, William A Gower, Maximiliano Tamae-Kakazu, Shivanthan Shanthikumar, Saumini Srinivasan, Erin E Reardon, Amisha V Barochia, Edward Charbek, Charlotte Calvo, Pi Chun Cheng, Shailendra Das, Stella M Davies, Jessica Gross, Ajay Sheshadri, Christoper T Towe, Samuel B Goldfarb, Narayan P Iyer

Faculty, Staff and Students Publications

Background: Bronchiolitis obliterans syndrome (BOS) represents a significant source of morbidity and non-relapse mortality among children and young adults treated with allogeneic hematopoietic stem cell transplantation (aHSCT). Pulmonary function testing (PFT) pre- and post-aHSCT may allow for pre-symptomatic detection of BOS, and thus early intervention. Current guidelines and practices vary regarding which tests to perform and timing relative to transplant. A systematic review evaluating PFT before and after pediatric aHSCT was conducted to inform American Thoracic Society clinical practice guidelines on detection of BOS.

Objective: To determine the optimal approach to conducting PFT prior to and after pediatric aHSCT.

Study …

The Diagnostic Role Of Pharmacological Provocation Testing In Cardiac Electrophysiology: A Clinical Consensus Statement Of The European Heart Rhythm Association And The European Association Of Percutaneous Cardiovascular Interventions (Eapci) Of The Esc, The Esc Working Group On Cardiovascular Pharmacotherapy, The Association Of European Paediatric And Congenital Cardiology (Aepc), The Paediatric & Congenital Electrophysiology Society (Paces), The Heart Rhythm Society (Hrs), The Asia Pacific Heart Rhythm Society (Aphrs), And The Latin American Heart Rhythm Society (Lahrs), Elijah R Behr, Bo Gregers Winkel, Bode Ensam, Alberto Alfie, Elena Arbelo, Colin Berry, Marina Cerrone, Giulio Conte, Lia Crotti, Cecilia M Gonzalez Corcia, Juan Carlos Kaski, Koonlawee Nademanee, Pieter G Postema, Silvia Priori, Vincent Probst, Georgia Sarquella-Brugada, Eric Schulze-Bahr, Rafik Tadros, Arthur Wilde, Jacob Tfelt-Hansen, Christian Wolpert, Alejandro Cuesta, Peter Damman, Dobromir Dobrev, Fabrizio Drago, Kristina Haugaa, Andrew Krahn, Ulrich Krause, Pier D Lambiase, Carlo Napolitano, Katja E Odening, Wataru Shimizu, Christian Veltmann

Faculty, Staff and Students Publications

The pharmacological provocation test is a pivotal tool in cardiac electrophysiology for the diagnosis of potential causes of sudden cardiac death, sudden cardiac arrest (SCA), arrhythmias, symptoms, or ECG abnormalities. The 2022 European Society of Cardiology Guidelines for the Treatment of Ventricular Arrhythmias and Prevention of Sudden Cardiac Death offered guidance on provocation testing but did not describe the indications and requirements in depth. This clinical consensus statement, led by the European Heart Rhythm Association and approved by major international stakeholders, aims to advise the general cardiologist and the arrhythmia expert who to test and when, where, and how to …

Enhancing Lymphoma Staging: Unveiling The Potential And Challenges Of Whole-Body Magnetic Resonance Imaging, Mohadese Ahmadzade, Mohammad Ghasemi-Rad

Faculty, Staff and Students Publications

In this editorial, we comment on the article by Lambert et al, published in the recent issue of the World Journal of Radiology. The focus of the editorial is to explore the advancements in whole-body magnetic resonance imaging (WB-MRI) technology, its current clinical applications, and the challenges that must be addressed to fully realize its potential in oncological imaging. WB-MRI has emerged as a pivotal tool in oncological imaging, offering comprehensive disease assessment without ionizing radiation. Its applications span the detection of bone metastases, evaluation of hematologic malignancies, and staging of a wide range of cancers, including lymphoma, …

Dock2 Deficiency And Gata2 Haploinsufficiency Can Underlie Critical Coronavirus Disease 2019 (Covid-19) Pneumonia, Sajjad Biglari, Leila Youssefian, Mohammad Amin Tabatabaiefar, Amir Hossein Saeidian, Bahareh Abtahi-Naeini, Erfan Khorram, Roya Sherkat, Atefeh Sohanforooshan Moghaddam, Fatemeh Mohaghegh, Maziyar Rahimi, Hamid Rahimi, Sharareh Babaei, Mohammad Shahrooei, Nikoo Mozafari, Shirin Zaresharifi, Fatemeh Vahidnezhad, Vida Homayouni, Lam C Tsoi, Johann E Gudjonsson, Hakon Hakonarson, Jean-Laurent Casanova, Emmanuelle Jouanguy, Vivien Béziat, Qian Zhang, Aurélie Cobat, Hassan Vahidnezhad

Faculty, Staff and Students Publications

The life-threatening coronavirus disease 2019 (COVID-19) affects about 1 in 1,000 healthy people under 50 without underlying conditions. Among patients with critical COVID-19 pneumonia, rare germline variants at genes controlling type I IFN immunity have been reported in up to 5% of patients. Causal etiologies in 80-85% of cases are still unknown. We analyzed two families with hypoxemic COVID-19 pneumonia for known single-gene inborn errors of immunity. In Family 1, two siblings with critical COVID-19 were homozygous for a DOCK2 variant, c.3624+5G>A. DOCK2 deficiency is a known T-cell disorder underlying severe viral diseases. The variant resulted in skipping exon …

Amniotic Fluid-Derived Mesenchymal Stem Cells As A Therapeutic Tool Against Cytokine Storm: A Comparison With Umbilical Cord Counterparts, Salvatore Vaiasicca, David W James, Gianmarco Melone, Omar Saeed, Lewis W Francis, Bruna Corradetti

Faculty, Staff and Students Publications

Background: Several immunosuppressive therapies have been proposed as key treatment options for critically ill patients since the first appearance of severe acute respiratory syndrome coronavirus 2. Mesenchymal stem cells (MSCs) from different sources have been considered for their potential to attenuate the cytokine storm associated to COVID-19 and the consequent multi-organ failure, providing evidence for safe and efficacious treatments. Among them, administration of umbilical cord-derived MSCs (UC-MSCs) has demonstrated a significant increase in survival rates, largely due to their potent immunosuppressive properties.

Methods: We applied next-generation sequencing (NGS) analysis to compare the transcriptomic profiles of MSCs isolated from two gestational …

Advancing Provider Knowledge On Precedex Use To Prevent Postoperative Delirium Through Targeted Education, Brian Gibbs

Scholars Week

Postoperative delirium (POD) is a serious and multifactorial complication commonly affecting elderly surgical patients. POD is associated with increased morbidity, longer hospital stays, and higher mortality rates. The use of benzodiazepines and opioids during the perioperative period is a significant modifiable risk factor for POD. Despite the potential of Dexmedetomidine (Precedex) to reduce POD incidence due to its sedative, and analgesic properties, it is not widely available in many operating rooms (OR). This project aimed to educate anesthesia providers on the benefits of Precedex and its role in reducing POD in patients over 65 years old. A quality improvement project …

Ai In Radiology: Bridging The Gap Between Technology And Patient Care, Jordan Watts, Jeffrey Larson, Kasi Gorli, Alberto Coustasse

Management Faculty Research

Artificial Intelligence (AI) integration in healthcare, particularly within radiology, has grown rapidly, with 400 out of 520 FDA-approved AI algorithms explicitly designed for radiological applications as of 2023. AI has shown significant potential for enhancing healthcare delivery and improving patient outcomes (AHA, 2023); however, understanding the barriers, facilitators, and implications of AI implementation in radiology remains fragmented across existing studies. This study investigates AI's impact on radiology in three critical areas: diagnostic accuracy, interpretation times, and clinical workflow efficiency. We synthesize key findings regarding AI's contributions to radiology practices through a comprehensive literature review of 29 articles published between 2015 …

Colorectal Cancer Screening And Correlating Gender Disparities, Kara Marr, Megan Janssen, Margaret Payne, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

In 2023, colorectal cancer (CRC) was the second leading cause of cancer-related deaths in the US, equating to approximately 50,000 total deaths (National Cancer Institute, 2024). Further, it is estimated that an additional 1.4 million Americans are living with CRC (National Cancer Institute, 2024). Early detection screening modalities remain imperative since the NIH has released a combined survival rate of 70% when utilized (National Cancer Institute, 2024). Different derivatives of CRC develop from pre-cancerous polyps and are often without signs or symptoms of disease progression; this asymptomatic period emphasizes the importance of early detection and prevention of colorectal cancer …

Evaluating A Large Language Model’S Accuracy In Chest X-Ray Interpretation For Acute Thoracic Conditions, Adam M. Ostrovsky

SKMC Student Presentations and Publications

BACKGROUND: The rapid advancement of artificial intelligence (AI) has great ability to impact healthcare. Chest X-rays are essential for diagnosing acute thoracic conditions in the emergency department (ED), but interpretation delays due to radiologist availability can impact clinical decision-making. AI models, including deep learning algorithms, have been explored for diagnostic support, but the potential of large language models (LLMs) in emergency radiology remains largely unexamined.

METHODS: This study assessed ChatGPT's feasibility in interpreting chest X-rays for acute thoracic conditions commonly encountered in the ED. A subset of 1400 images from the NIH Chest X-ray dataset was analyzed, representing seven pathology …

An Assessment Of The Performance Of Different Chatbots On Shoulder And Elbow Questions, Mohamad Y. Fares, Tarishi Parmar, Peter Boufadel, Mohammad Daher, Jonathan Berg, Austin Witt, Brian W. Hill, John G. Horneff, Adam Z. Khan, Joseph A. Abboud

Rothman Institute Papers

Background/Objectives: The utility of artificial intelligence (AI) in medical education has recently garnered significant interest, with several studies exploring its applications across various educational domains; however, its role in orthopedic education, particularly in shoulder and elbow surgery, remains scarcely studied. This study aims to evaluate the performance of multiple AI models in answering shoulder- and elbow-related questions from the AAOS ResStudy question bank.

Methods: A total of 50 shoulder- and elbow-related questions from the AAOS ResStudy question bank were selected for the study. Questions were categorized according to anatomical location, topic, concept, and difficulty. Each question, along with the …

Left Ventricular And Aortic Pressures Measured With Fluid-Filled And Solid-State Pressure Catheters: Similarities And Differences, Priscilla Machado, Ira Cohen, Brian Osler, Maureen E. Mcdonald, Cara Esposito, Marguerite Davis, David Fischman, Michael P. Savage, Praveen Mehrotra, Flemming Forsberg, Jaydev K. Dave

Division of Cardiology Faculty Papers

Objective: To compare left ventricular (LV) and aortic (AO) pressures obtained using fluid-filled and high-fidelity solid-state pressure catheters in subjects undergoing left heart catheterization.

Materials and Methods: Twenty subjects scheduled for a left heart catheterization were enrolled and 18 subjects completed this IRB-approved study. LV and AO pressures were obtained using fluid-filled pressure catheter (standard-of-care) and high-fidelity solid-state pressure catheter synchronously. Pressure tracings were analyzed to measure LV systolic (LVSP), LV minimum-diastolic (LVMDP), LV end-diastolic (LVEDP), AO systolic (AOSP), and AO diastolic (AODP) pressures. Isovolumic contraction and relaxation rates (peak ± dp/dt) were derived from the pressure waveforms. Repeated measures …

Wound Dehiscence Rate Between Chevron Osteotomy Procedure Vs. Lapidus For Correction Of Hallux Valgus Deformity, Isabella V. Strash, Abelardo Osuna, Madelaine Adkins

School of Podiatric Medicine - Student Research

Format: Scientific

Length of follow-up: n/a

Level of Evidence: Cross-Sectional Study (Level III)

Classification: Surgery

Purpose: Distal metatarsal osteotomies, like the chevron procedure, were once preferred for their stability and faster recovery in hallux valgus correction. However, recent advancements have increased the use of proximal procedures, such as the lapidus. This study aims to compare complications between distal and proximal hallux valgus surgeries.

Methodology & Procedure: Data was downloaded from the TriNetX Research Network on February 2, 2023 using CPT codes 28296 (chevron) and 28297 (lapidus). Inclusion criteria consisted of patients between 18 and 60 years of age and required …

Introducing Kids To Cultural Cuisines, Maggie Mckay, Rachel Finn

Parent-ish Podcast

While it can be easy to lean on your tried and true, family-favorite recipes, introducing children to diverse cuisines is a wonderful way to expand their understanding of different cultures while also trying new foods. As parents, we have the unique opportunity to use food as a tool for education and connection. Rachel Finn, chef/educator at Children's Mercy Kansas City, discusses how to involve kids in the process and make discovering new cuisines fun and nutritious for the whole family!

Click here to stream the podcast episode.

The Future Direction Of Post-Transcatheter Aortic Valve Replacement Reinterventions: Insights From The Transcatheter Valve Therapy Registry, Edward Percy, Joseph E. Bavaria

Division of Cardiology Faculty Papers

No abstract provided.

Reducing Clinical Trial Eligibility Barriers For Patients With Mds: An Icmds Position Statement, Uma Borate, Kelly Pugh, Allyson Waller, Rina Li Welkie, Ying Huang, Jan Philipp Bewersdorf, Maximilian Stahl, Amy E Dezern, Uwe Platzbecker, Mikkael A Sekeres, Andrew H Wei, Rena J Buckstein, Gail J Roboz, Michael R Savona, Sanam Loghavi, Robert P Hasserjian, Pierre Fenaux, David A Sallman, Christopher S Hourigan, Matteo Giovanni Della Porta, Stephen Nimer, Richard F Little, Valeria Santini, Fabio Efficace, Justin Taylor, Guillermo Garcia-Manero, Olatoyosi Odenike, Tae Kon Kim, Stephanie Halene, Rami S Komrokji, Elizabeth A Griffiths, Peter L Greenberg, Mina L Xu, Zhuoer Xie, Rafael Bejar, Guillermo F Sanz, Mrinal M Patnaik, Maria Figueroa, Hetty E Carraway, Omar Abdel-Wahab, Daniel Starczynowski, Eric Padron, Jacqueline Boultwood, Steven Gore, Naval G Daver, Jane E Churpek, Ravindra Majeti, John M Bennett, Alan F List, Andrew M Brunner, Amer M Zeidan

Faculty, Staff and Student Publications

Excessively restrictive inclusion and exclusion criteria in clinical trials are one of many barriers to clinical trial enrollment for patients with myelodysplastic syndromes/neoplasms (MDSs). Many organizations are developing efforts to increase clinical trial eligibility; yet, several recent publications focused on patients with MDS suggest that many patients with this disease may be excluded from clinical trials unnecessarily. Clinical trial eligibility should reflect the phase of the study and risks of the agent being studied. Phase 3 trials should be less restrictive than early-phase trials to represent the real-world population as closely as possible. We hypothesize that many clinical trials, particularly …

Mesenchymal Stem Cells Loaded In Injectable Alginate Hydrogels Promote Liver Growth And Attenuate Liver Fibrosis In Cirrhotic Rats, Dominic Karl M Bolinas, Allan John R Barcena, Archana Mishra, Marvin R Bernardino, Vincent Lin, Francisco M Heralde, Gouthami Chintalapani, Natalie W Fowlkes, Steven Y Huang, Marites P Melancon

Faculty, Staff and Student Publications

Cirrhosis, a marker of severe liver diseases, limits future liver remnant (FLR) growth, preventing many cancer patients from undergoing surgery. While portal vein blockade (PVB) techniques are used to stimulate liver regeneration, 20-30% of patients still fail to achieve the required growth. Although mesenchymal stem cell (MSC) therapy improves PVB, its efficacy is limited by poor cell retention. To address this, we utilized alginate hydrogels to deliver MSCs and improve their retention. MSCs were loaded in the hydrogel and injected intraportally in cirrhotic rats. Liver volume, weights, enzyme levels, and histology were monitored. Results showed that the hydrogel maintained 89.0 …

Management Of Parkinson's Disease Psychosis: First-Line Antipsychotic Selection And Rationale For Continuing, Combining, Or Switching, Stuart H. Isaacson, Henry Nasrallah, Rajesh Pahwa, Gustavo Alva, Daniel Kremens, Stephen M. Stahl

Department of Neurology Faculty Papers

INTRODUCTION: The past decade has seen a paradigm shift in the evaluation and management of Parkinson's disease psychosis (PDP), with the first approval of an antipsychotic in the US in 2016. An evidence-based review by the Movement Disorder Society found pimavanserin and clozapine to be clinically useful, (low-dose) quetiapine to be possibly useful, and all other antipsychotics to be avoided due to motor worsening. Clozapine and quetiapine use can be limited by provoking Parkinson's disease (PD) nonmotor symptoms of somnolence and hypotension. Quetiapine may also be limited by its risk in cognitive impairment. Pimavanserin is not associated with these symptoms. …

It’S All In The Wrist: Postoperative Complications Of Patients With Menopause In Endoscopic Versus Open Treatment Of Carpal Tunnel Syndrome, Sharon Shania Ms, Charlotte Floria Do, David Matera Do, Amir B. Behnam Md

Tower Health Research Day

No abstract provided.

Impact Of Early Term Labor Induction On Maternal And Fetal Outcomes In Patients With Obesity, Nathanael N. Hoskins, Xuezhi Jiang

Tower Health Research Day

No abstract provided.

Stercoral Colitis: A Case Of Severe Constipation, Ji Won Lee Bs, Anish Parameswaran Do

Tower Health Research Day

No abstract provided.

Effect Of Eye Position On Variability Of The Vestibulo-Ocular Reflex, Kathryn Mozzochi, Amsal Madhani, Michael D. Balkwill, Divya Chari, Faisal Karmali

Tower Health Research Day

No abstract provided.

Do Cervical Spine Injuries Require Airway Monitoring In The Surgical Intensive Care Unit?, Nikki Rimlinger, Tom Parker, Sujay Deshpande, Kyle Yang, Alison Muller Msph, Mls, Anthony Martin Rn, Bsn, Tcrn, Adrian Ong Md, Eugene F. Reilly Md, Mhci, Christopher A. Butts Phd, Do

Tower Health Research Day

No abstract provided.

Storm-Induced Supply Challenges: A Case Of Hurricane-Driven Iv Fluid Use And Venous Air Embolism, Davin Evanson

Tower Health Research Day

No abstract provided.

From Rights To Risks: Mental Health Implications For Pregnant Patients Following The Reversal Of Roe V. Wade, Andrew Murdock, Angelica Arshoun, Eduardo Espiridion

Tower Health Research Day

No abstract provided.

When Elevated Creatinine Is Not What It Seems: Intraperitoneal Urinary Leak Mimicking Acute Kidney Injury, Hatem Ahmed, Mohamed K. Mansour, Hamza Obeid

Tower Health Research Day

No abstract provided.

Case Report: Non-Operative Management Of A Diaphragmatic Hematoma, Taylor Gong, Kendall Ozorowski, Davin Evanson, Michael Romeo

Tower Health Research Day

No abstract provided.

Use Of Arrow Clarke Pleuraseal Thoracentesis Kit To Perform A Pericardiocentesis Emergency Medicine Physician Education Quality Improvement On High Acuity Low Occurrence Procedures, Kendall Higgins Md, Joshua Hamilton Do, Grant Nugent Md, Monisha Bindra Do, Shaila Quazi Do

Tower Health Research Day

No abstract provided.

Unlocking Prognostic Potential: Biomarker Predictors Of Admission And Length Of Stay In Pediatric Sickle Cell Vaso-Occlusive Pain Crisis, Jeffrey Hernandez, Abhishek Dutta, Jacob Lowry, Bruce Bernstein, Luis Gamboa, Nataly Apollonsky

Tower Health Research Day

No abstract provided.

Dyke-Davidoff-Masson Syndrome: A Rare Cause Of Drug Refractory Epilepsy In An Adult, Paresh Zanzmera, Vaidehi Chauhan, Tvisha Patel, Jaineel Patel, Ankit Dumaswala, Kinjal Shah

Tower Health Research Day

No abstract provided.