Medicine and Health Sciences Commons^™

Assessing Social Vulnerabilities Of Salivary Gland Cancer Care, Prognosis, And Treatment In The United States, Govind S. Bindra, David J. Fei-Zhang, Atharva Desai, John Maddalozzo, Stephanie S. Smith, Urjeet A. Patel, Daniel C. Chelius, Jill N. D'Souza, Jeffrey C. Rastatter, M. Boyd Gillespie, Anthony M. Sheyn

School of Medicine Faculty Publications

Background: Salivary gland cancers (SGC)-social determinants of health (SDoH) investigations are limited by narrow scopes of SGC-types and SDoH. This Social Vulnerability Index (SVI)-study hypothesized that socioeconomic status (SES) most contributed to SDoH-associated SGC-disparities. Methods: Retrospective cohort of 24 775 SGCs assessed SES, minority-language status (ML), household composition (HH), housing-transportation (HT), and composite-SDoH measured by the SVI via regressions with surveillance and survival length, late-staging presentation, and treatment (surgery, radio-, chemotherapy) receipt. Results: Increasing social vulnerability showed decreases in surveillance/survival; increased odds of advanced-presenting-stage (OR: 1.12, 95% CI: 1.07, 1.17), chemotherapy receipt (OR: 1.13, 95% CI: 1.03, 1.23); decreased odds …

Cellular Host Response Sepsis Test For Risk Stratification Of Patients In The Emergency Department: A Pooled Analysis, Hollis R. O'Neal, Roya Sheybani, Chadd K. Kraus, Wesley H. Self, Ajay M. Shah, Christopher B. Thomas, Henry T.K. Tse, Robert Scoggins

School of Medicine Faculty Publications

Objectives: Sepsis is one of the most common, costly, and misdiagnosed conditions in U.S. emergency departments (EDs). ED providers often treat on nonspecific signs, subjective suspicion, or presumption of infection, resulting in over- and undertreatment. An increased understanding of host response has opened a new direction for sepsis diagnostics. The IntelliSep test is a U.S. Food and Drug Administration–cleared cellular host response diagnostic that could help distinguish sepsis in ED settings. Our objective was to evaluate the potential of the cellular host response test to expedite appropriate care for patients who present with signs of infection. Methods: We performed a …

Latent Tb Treatment Regimens In 2023: Wetmore Tb Clinic In New Orleans, Amy Wolfe, Priyanka Jadhav, Amber May, Shandrica Seymour, Angela Blanchard, Juzar Ali

School of Medicine Faculty Publications

The USPSTF has updated Latent TB Infection (LTBI) screening and treatment recommendations in 2023; describing treatment courses, side effects and benefits associated with each regimen. Overall, rifampin-containing shortened regimens are the preferred modality for LTBI treatment. A recent study in 2023 evaluated adherence and tolerance of the isoniazid(INH) + rifapentine(RPT), or “3HP” regimen and identified patient groups that may be at higher risk for non-completion of this regimen. It emphasized the need for targeted education at the beginning of treatment, to avoid early discontinuation. Our experience in New Orleans demonstrated that the 3HP is well-tolerated, with higher completion rates than …

Uterine Adenosarcoma Presenting As Uterine Inversion: A Case Study, Caitlin Witt, Chelsey Vranes, Leslie H. Clark

School of Medicine Faculty Publications

No abstract provided.

Trends In Medicare Utilization And Reimbursement For Hematology/Oncology Procedures From 2012 To 2023: A Geriatric Oncology Perspective, Julijana Conic, Thomas Reske

School of Medicine Faculty Publications

Objectives: Given the scarcity of data exploring reimbursement trends in the field of hematology/oncology, we sought to characterize these trends for common procedures in this field from 2012 to 2023. Methods: Using the Centers for Medicare and Medicaid Services' Physician Fee Schedule Look-Up Tool we collected reimbursement data for 40 hematology/oncology procedure codes from 2012 to 2023. Data was adjusted to 2023 United States (US) dollars using the Consumer Price Index (CPI). Results: From 2012 to 2023 gross reimbursement for the facility price decreased 4.4% and increased 9.2% for the non-facility price. When adjusted for inflation, compensation decreased 96.1% and …

Gut Microbial Dysbiosis Differs In Two Distinct Cachectic Tumor-Bearing Models Consuming The Same Diet, Lauri O. Byerley, Brittany Lorenzen, Hsiao Man Chang, William G. Hartman, Michael J. Keenan, Ryan Page, Meng Luo, Scot E. Dowd, Christopher M. Taylor

School of Medicine Faculty Publications

The impact of cancer cachexia on the colonic microbiota is poorly characterized. This study assessed the effect of two cachectic-producing tumor types on the gut microbiota to determine if a similar dysbiosis could be found. In addition, it was determined if a diet containing an immunonutrient-rich food (walnuts) known to promote the growth of probiotic bacteria in the colon could alter the dysbiosis and slow cachexia. Male Fisher 344 rats were randomly assigned to a semi-purified diet with or without walnuts. Then, within each diet group, rats were further assigned randomly to a treatment group: tumor-bearing ad libitum fed (TB), …

Covid-19 Vaccination In Patients With Inborn Errors Of Immunity Reduces Hospitalization And Critical Care Needs Related To Covid-19: A Usidnet Report, John Mcdonnell, Kimberley Cousins, M. Elizabeth M. Younger, Adam Lane, Hassan Abolhassani, Roshini S. Abraham, Salem Al-Tamemi, Juan Carlos Aldave-Becerra, Eman Hesham Al-Faris, Alberto Alfaro-Murillo, Suzan A. Alkhater, Nouf Alsaati, Alexa Michelle Altman Doss, Melissa Anderson, Ernestina Angarola, Barbara Ariue, Danielle E. Arnold, Amal H. Assa'ad, Caner Aytekin, Meaghan Bank, Jenna R.E. Bergerson, Jack Bleesing, John Boesing, Carolina Bouso, Nicholas Brodszki, Diana Cabanillas, Carol Cady, Meghan A. Callahan, Luke Wall, Et Al

School of Medicine Faculty Publications

BACKGROUND: The CDC and ACIP recommend COVID-19 vaccination for patients with inborn errors of immunity (IEI). Not much is known about vaccine safety in IEI, and whether vaccination attenuates infection severity in IEI. OBJECTIVE: To estimate COVID-19 vaccination safety and examine effect on outcomes in patients with IEI. METHODS: We built a secure registry database in conjunction with the US Immunodeficiency Network to examine vaccination frequency and indicators of safety and effectiveness in IEI patients. The registry opened on January 1, 2022, and closed on August 19, 2022. RESULTS: Physicians entered data on 1245 patients from 24 countries. The most …

A Brief Review Of Complex Regional Pain Syndrome And Current Management, Alaa Abd-Elsayed, Cain W. Stark, Natasha Topoluk, Mir Isaamullah, Paul Uzodinma, Omar Viswanath, Michael J. Gyorfi, Osama Fattouh, Kevin C. Schlidt, Omar Dyara

School of Medicine Faculty Publications

Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that, although exceedingly rare, carries a significant burden for the affected patient population. The complex and ambiguous pathophysiology of this condition further complicates clinical management and therapeutic interventions. Furthermore, being a diagnosis of exclusion requires a diligent workup to ensure an accurate diagnosis and subsequent targeted management. The development of the Budapest diagnostic criteria helped to consolidate existing definitions of CRPS but extensive work remains in identifying the underlying pathways. Currently, two distinct types are identified by the presence (CRPS type 1) or absence (CRPS type 2) of neuronal …

Genetic Ancestry And Radical Prostatectomy Findings In Hispanic/Latino Patients, Natalia L. Acosta-Vega, Rodolfo Varela, Jorge Andrés Mesa, Jone Garai, Alberto Gómez-Gutiérrez, Silvia J. Serrano-Gómez, Jovanny Zabaleta, María Carolina Sanabria-Salas, Alba L. Combita

School of Medicine Faculty Publications

Background: African ancestry is a known factor associated with the presentation and aggressiveness of prostate cancer (PC). Hispanic/Latino populations exhibit varying degrees of genetic admixture across Latin American countries, leading to diverse levels of African ancestry. However, it remains unclear whether genetic ancestry plays a role in the aggressiveness of PC in Hispanic/Latino patients. We explored the associations between genetic ancestry and the clinicopathological data in Hispanic/Latino PC patients from Colombia. Patients and methods: We estimated the European, Indigenous and African genetic ancestry, of 230 Colombian patients with localized/regionally advanced PC through a validated panel for genotypification of 106 Ancestry …

Orthopaedic Infections: A Primer, Gregory Laborde

Medicine Research Day

Background: In a 1992 Internal Medicine Grand Rounds presentation that focused on medical education, Dr. Frank Griffin, Jr. made the comment that “understanding is the key to learning” (Griffin, 1992). His contention was that for information to be effectively retrieved, it must first be efficiently stored. Griffin said that the focus is usually on acquiring a “morass of details,” which precludes the commitment of time to consider concepts. Memorizing mounds of facts without having an effective conceptual framework to store them is often an unsuccessful learning style because memory frequently fails without understanding. To accomplish this goal, we offer a …

Investigating An Adaptive Target Biofeedback Paradigm To Reduce Gait Asymmetry In Older Adults Post-Stroke, John Macaulay

Medicine Research Day

Background: Stroke is one of the most common causes of long-term disability in the United States and can present with debilitating motor impairment. Asymmetric walking patterns due to hemiparesis are energetically costly and impair walking performance. For this reason, gait asymmetry is an important target of clinical gait training and post stroke rehabilitation research. Visual gait biofeedback training is an effective, well-studied way to alter walking patterns in people with chronic stroke. However, there exists large methodological variability between studies with discrepancies in feedback target and feedback structure. The objective of this study was to determine the utility of a …

Does Preoperative Antibiotic Timing Prior To Incision And Drainage Procedures For Severe Odontogenic Infections Affect Length Of Stay Or Reoperation, Dylan Mire

Medicine Research Day

Background: An odontogenic infection can be a life-threatening medical condition which requires incision and drainage (I&D) in the operating room. Prior to these procedures, many patients are started on antibiotics; however, the effects of the timing of starting the antibiotics prior to surgery is not known. Methods: The authors conducted a retrospective cohort study consisting of all adult patients treated in the OR with I&D for odontogenic infections from 1/1/2015 to 7/30/2021 at a large, urban academic hospital. The primary predictor variable was preoperative antibiotic timing—the amount of time between when the antibiotic was given before surgery and incision time. …

Food For Thought: The Cognitive Effects Of Mediterranean, High-Fat Low Carbohydrate, And Traditional American Diets – Study Design, Audrey Smets

Medicine Research Day

Background Dietary patterns have long been associated with a range of health outcomes. Findings from cross-sectional studies suggest that dietary patterns can affect cognitive function. Mediterranean diets, rich in fruits, vegetables, olive oil, and fish, have been associated with improved cognitive function and reduced risk of cognitive decline. Conversely, the standard American diet, rich in saturated fats and sugars, has been linked with adverse cognitive outcomes. Findings regarding the effects of low-carb diets are mixed. However, some studies have reported potential cognitive benefits. Hypothesis A two-week consumption of high-fat diets, such as the standard American diet and high-fat, low-carbohydrate diets, …

Update: Ascertaining Barriers To Anal Cancer Prevention In People Living With Hiv From The Patient Perspective, Amber Trauth

Medicine Research Day

Background: The general population in the U.S. has a 1 in 500 lifetime risk of developing anal cancer. There is 19-fold increase in anal cancer risk among all HIV positive people and a 37-fold increase in risk for HIV+ MSMs. Despite modest improvements in access to anal pap smears and high resolution anoscopy (HRA) in the U.S., these screening modalities remain underutilized by at-risk groups. To date, few studies have explored the factors contributing to non-adherence to anal cancer screening recommendations among HIV positive at-risk people. No studies have focused on HIV positive people living in Louisiana despite the state …

Complexity Of Chronic Suppurative Otitis Media In The Setting Of Immunodeficiency And Drug-Reactions, Bryce Arata

Medicine Research Day

A 9-year-old female was admitted to the pediatric hospital medicine service for bilateral otalgia, postauricular pain, and blood-tinged otorrhea from the left ear concerning for acute mastoiditis. Relevant past medical history included chronic suppurative otitis media with conductive hearing loss, recurrent upper respiratory infections, and a nonspecific B-cell immunodeficiency. Surgical and social histories respectively included 10 tympanoplasties in the past 5 years and 42 missed school days in the last academic year. She was followed by ENT and Allergy-Immunology with plan for mastoidectomies in 4-6 months as well as IVIG. Upon further review, the patient had been hospitalized multiple times …

A Tail Of A Pancreatic Duct Fistula, Nikki Arceneaux

Medicine Research Day

Introduction: Pancreatic duct fistulas are characterized by an abnormal communication between the pancreatic duct and surrounding tissues or organs. This pathological entity poses significant challenges in clinical management due to its diverse etiology, variable clinical presentations, and potential for serious complications. Understanding the underlying mechanisms and clinical implications of pancreatic duct fistulas are essential for improving diagnostic accuracy, optimizing treatment strategies, and enhancing patient outcomes. Case: A 70-year-old male with a past medical history of hypertension, alcohol use, and cataracts presented to the Emergency Department for one week of abdominal pain as well as decreased appetite for two weeks. Upon …

Under The Collarbone: A Case Of Primary Sternal And Clavicular Osteomyelitis, Nikki Arceneaux

Medicine Research Day

Introduction: Primary sternal osteomyelitis (PSO) is a rare but life-threatening condition. This case underscores the diagnostic challenges of PSO, highlighting the significance of early culture-based pathogen identification and the potential success of conservative management when patients respond well to antibiotics. Case: A 41-year-old female with a past medical history of obesity, uncontrolled type 2 diabetes, hypertension, and intravenous drug use complicated by necrotizing fasciitis of the left forearm presented to the Emergency Department for acute left chest pain and purulence of left forearm wounds for two days. Her exam was significant for tenderness to palpation to the anterior chest, left …

Surreptitious Diuretic Abuse In A Patient With Severe Hypokalemia And Long Qt Syndrome, Claire Carr

Medicine Research Day

The patient in question was a 45 year old female with past medical history of long QT syndrome who presented to the emergency department with a chief complaint of chest pain and shortness of breath for 3 days. The patient was in her usual state of health until 3 days prior to admission, when she began experiencing a pressure-like chest pain associated with progressively worsening dyspnea. At baseline, the patient does not experience dyspnea and walks one mile every day without difficulty. Her new-onset dyspnea was present both with exertion and at rest. Her symptoms continued to progress and prompted …

Jaundice With Markedly Elevated Carbohydrate Antigen 19-9 (Ca 19-9): Biliary Stones Or Malignancy?, Brianna Bourgeois

Medicine Research Day

A 59-year-old male with past medical history of untreated type 2 diabetes mellitus, hypertension, and hyperlipidemia presents to the UMC family medicine clinic for a follow up for chronic conditions after being lost to follow up for about 2.5 years. On initial observation, the patient appeared jaundiced. The jaundice is not associated with nausea, vomiting, diarrhea, or constipation. The patient does have generalized pruritus. He denied having pain in spite of questioning during the first two family medicine visits and the first visit with gastroenterology. However, on the 3rd Family Medicine visit, the patient admitted to the medical student that …

Surreptitious Diuretic Abuse In A Patient With Severe Hypokalemia And Long Qt Syndrome, Claire Carr

Medicine Research Day

Surreptitious Diuretic Abuse in a Patient with Severe Hypokalemia and Long QT Syndrome Claire Carr, MS3, LSU School of Medicine- New Orleans, Kyle Hoppens, MD, LSUHSC The patient in question was a 45 year old female with past medical history of long QT syndrome who presented to the emergency department with a chief complaint of chest pain and shortness of breath for 3 days. The patient was in her usual state of health until 3 days prior to admission, when she began experiencing a pressure-like chest pain associated with progressively worsening dyspnea. At baseline, the patient does not experience dyspnea …

Case Report: A Case Of Coccidiomycosis Confounding A Systemic Lupus Erythematosus Diagnosis, Lily Chen

Medicine Research Day

Lily Chen, Sidney Mejia, Lydia Rewers and Seema Walvekar Introduction: Systemic Lupus Erythematosis is a rare autoimmune disease with prevalence of 20-150 cases per 100,000 in the United States. Despite increased awareness among physicians and improvements in serologic testing, the time to diagnosis from symptom onset is still delayed for many patients, with one study estimating the average time to diagnosis of 6 years. One significant cause of diagnostic delay is due to the heterogeneity in the disease presentation, with symptoms that can present similarly to many other autoimmune, infectious, or hematologic diseases. Many of the symptoms of SLE are …

Jaundice With Markedly Elevated Carbohydrate Antigen 19-9 (Ca 19-9): Biliary Stones Or Malignancy, Brianna Bourgeois

Medicine Research Day

A 59-year-old male with past medical history of untreated type 2 diabetes mellitus, hypertension, and hyperlipidemia presents to the UMC family medicine clinic for a follow up for chronic conditions after being lost to follow up for about 2.5 years. On initial observation, the patient appeared jaundiced. The jaundice is not associated with nausea, vomiting, diarrhea, or constipation. The patient does have generalized pruritus. He denied having pain in spite of questioning during the first two family medicine visits and the first visit with gastroenterology. However, on the 3rd Family Medicine visit, the patient admitted to the medical student that …

A Case Of Recurrent Head And Neck Dermatofibrosarcoma Protuberans, Kathryn Dillman

Medicine Research Day

Title: A Case of Recurrent Head and Neck Dermatofibrosarcoma Protuberans Authors and Affiliations: Kathryn Dillman, BS; Nicholas Culotta, MD; Christopher Haas, MD; LSU School of Medicine New Orleans and LSU Department of Dermatology Patient Initials: DF History of Present Illness: Personal Data: 68 y.o. M Patient is a 68-year-old male with a history of dermatofibrosarcoma protuberans (DFSP) of the left cheek who presented to dermatology clinic for follow-up skin exam. He noted a few concerning lesions on the trunk and the face that he would like examined, but denied any bleeding, ulceration, enlarging, or non-healing lesions. He initially reports a …

An Ironic Electrolyte Imbalance: A Hyperkalemic Emergency In Primary Hyperaldosteronism, Amded-Fazal-Ur Rehman

Medicine Research Day

Title: An Ironic Electrolyte Imbalance: A Hyperkalemic Emergency in Primary Hyperaldosteronism Ahmed Fazul-ur-rehman, Asad Mussarat MD, Luke Yesbeck DO, Angus Harper MD, Ashley Van MD, Sumrita Bindra DO, Rebecca Maitski, Brian Mackel MD, Seth Vignes, MD Department of Internal Medicine, LSU Health Sciences Center Introduction: Hyperkalemia is a common medical emergency that can lead to life-threatening complications, including muscle weakness, paralysis, and worst arrhythmias due to cardiac membrane instability. Primary hyperaldosteronism is a disorder where excess aldosteronism promote intravascular volume expansion and renal loss of serum potassium. When treated, however, patients’ electrolyte imbalance overcompensates and can presents with hyperkalemia. We …

Aseptic Meningitis As The Sole Symptom Of Legionnaire’S Disease, Michael Forte

Medicine Research Day

Aseptic Meningitis as the Sole Symptom of Legionnaire’s Disease • Michael Forte (LSU HSC School of Medicine) mfort1@lsuhsc.edu • William Benton, M.D. (LSU HSC Department of Internal Medicine, Baton Rouge) wbento@lsuhsc.edu CASE PRESENTATION A 41-year-old incarcerated male with a history of migraines and prior tobacco use presented in late summer with fevers, headaches, neck stiffness, and body aches for four days. He was sent to the ED for further evaluation after recording a temperature of 104° at the prison’s infirmary. On evaluation in the ED, his temperature was 99.5°F, and his heart rate was 105 bpm. He was diaphoretic, and …

Gabapentin To Cyclobenzaprine: A Case Of Acute Reversible Iatrogenic Psychosis Influenced By Schedule V Classifications, Grant Collins

Medicine Research Day

Clinical guidelines within psychiatric therapeutics continuously evolve, leading to varying exposure of specific population subgroups to particular therapeutic classes of medication. Such shifts are crucial, as these subgroups might be more susceptible to adverse reactions not common in the broader population. One pertinent example of this occurrence is the classification of Gabapentin as a Schedule V drug such as in Kentucky; which will likely lead to increased prescription rates of alternatives such as cyclobenzaprine (Flexeril®) in subgroups prone to recreational drug use. We present a case of a young incarcerated individual who developed acute mania after switching from gabapentin to …

Chronic Osteomyelitis Predictors With Pattern Of Care And Health Services, Thuc Truong

Medicine Research Day

Background: Chronic osteomyelitis is an infection of the bone presenting at a point in time after an acute injury or trauma. The infection may occur due to a multitude of reasons, but a couple would be open wounds or biofilms created by pathogens on implanted hardware. Commensal staphylococci are the most common cause of osteomyelitis1 . Management of chronic osteomyelitis can either be surgical with irrigation and debridement, a course of antibiotics ranging from four to six weeks, or a combination of both2 . Chronic osteomyelitis can complicate the healing process, but also place a burden on the patient if …

An Atypical Case Of Sweet Syndrome, Samuel Halle

Medicine Research Day

Title: An Atypical Case of Sweet Syndrome

Authors and Affiliations: Samuel Halle, LSU School of Medicine MD Candidate; Michael Olejniczak, LSUNO Comprehensive Medicine House Officer; Mohammed Ziada, LSUNO Assistant Professor; Daniel Provenzano, LSUNO Anesthesiology; Peyton Hopkins, LSUNO Comprehensive Medicine

Case Presentation: A 68-year-old female with a PMH of progressive CKD5, and Type II Diabetes Mellitus bounces back to the UMC ED with blurry vision, ocular disturbances, abdominal pain, and progressive weakness. Things have just been getting worse for her. Two days ago she was discharged with a large conjunctival mass with instructions to seek treatment at an Ophthalmology center, but …

Vaping-Related Pneumomediastinum In The Younger Patient Population, Andrew Hoang

Medicine Research Day

Title: Vaping-related pneumomediastinum in the younger patient population Authors: Andrew Hoang BS, Arash Ataei MD, Paul Videau MD, Michael Olejniczak MD, Victoria Lulich MD, Hunner Luke MD, Briggs Welch MD, Taylor Sanders MD, Najy Masri MD

Introduction: Herein, we describe a case of a young patient presenting with pneumomediastinum (PM) associated with vaping use. PM is due to air leaking within the mediastinal tissues that can travel to associated structures, often classified as spontaneous or traumatic. PM is an uncommon complication of asthma and often presents with acute chest pain or shortness of breath.1 While relatively rare, it is more …

A Case Of Malignant Melanoma In A Fitzpatrick Type Iii Male Patient, Lisa Kam

Medicine Research Day

Title: A Case of Malignant Melanoma in a Fitzpatrick Type III Male Patient

Authors and Affiliations: Dr. Deborah C. Hilton, MD, LSUHSC New Orleans; Lisa Kam, BS, MS, LSUHSC New Orleans.

Case Presentation: We present a 36-year old African American patient with a slow growing lesion on his left ear since he was 10 years old. The patient denied symptoms of fever, chills, nausea, vomiting, weight loss, and myalgias. He stated that the lesion was “burned off” in childhood, and observed recurrence of the nodule two years before visiting our clinic. The lesion measured 9mm in diameter upon presentation. Tangential …