Medicine and Health Sciences Commons^™

Induction Of Peripheral Tolerance In Ongoing Autoimmune Inflammation Requires Interleukin 27 Signaling In Dendritic Cells, Rodolfo Thome, Jason N. Moore, Elisabeth R. Mari, Javad Rasouli

Department of Neurology Faculty Papers

Peripheral tolerance to autoantigens is induced via suppression of self-reactive lymphocytes, stimulation of tolerogenic dendritic cells (DCs) and regulatory T (Treg) cells. Interleukin (IL)-27 induces tolerogenic DCs and Treg cells; however, it is not known whether IL-27 is important for tolerance induction. We immunized wild-type (WT) and IL-27 receptor (WSX-1) knockout mice with MOG_35-55 for induction of experimental autoimmune encephalomyelitis and intravenously (i.v.) injected them with MOG_35-55 after onset of disease to induce i.v. tolerance. i.v. administration of MOG^35-55 reduced disease severity in WT mice, but was ineffective in Wsx^-/- mice. IL-27 signaling in DCs was …

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

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Comparing Urban And Rural Vulnerability To Heat-Related Mortality: A Systematic Review And Meta-Analysis, Ying Li, Emmanuel A. Odamne, Ken Silver, Shimin Zheng

ETSU Faculty Works

Studies of the adverse impacts of high temperature on human health have primarily focused on urban areas, due in part to urban centers generally having higher population density and often being warmer than surrounding rural areas (the “urban heat island” effect). As a result, urban areas are often considered to be more vulnerable to summer heat. However, heat vulnerability may not only be determined by heat exposure, but also by other population characteristics such as age, education, income, baseline health status, and social isolation. These factors are likely to increase vulnerability among rural populations compared to urban populations. In this …

Ensuring Student Success In A Time Of Mergers And Acquisitions., Margaret A. Hadinger Edd, Ms, Lissette Ortiz Bba

Department of Education

No abstract provided.

How Youth Education Programs Can Impact The Nursing Shortage, Kerri Green Ms, Med., Emilie Carlino

Department of Education

No abstract provided.

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

The University of Louisville Journal of Respiratory Infections

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

Methods: …

Lessons From The Field: The Conduct Of Randomized Controlled Trials In Botswana., Janice M. Bonsu, Rosemary Frasso, Allison E. Curry

College of Population Health Faculty Papers

BACKGROUND: The conduct of randomized controlled trials (RCTs) in low-resource settings may present unique financial, logistic, and process-related challenges. Middle-income countries that have comparable disease burdens to low-income countries, but greater availability of resources, may be conducive settings for RCTs. Indeed, the country of Botswana is experiencing a rapid increase in the conduct of RCTs. Our objective was to explore the experiences of individuals conducting RCTs in Botswana to gain an understanding of the challenges and adaptive strategies to their work.

METHODS: We conducted in-depth interviews with 14 national and international individuals working on RCTs in Botswana. Participants included principal …

An Adult With Polyneuropathy And Hypogonadism Due To Poems Syndrome, Saba Zaidi, Sidra Sattar, Bhojo A Khealani

Section of Neurology

POEMS (acronym for polyneuropathy, organomegaly, endocrinopathy, M protein myeloma and skin changes), is a rare disease which occurs in the setting of plasma cell dyscrasias. We describe a case of an adult lady who presented with gradual onset weakness of all four limbs and multisystem involvement characterized by pedal edema, ascites, hyperpigmentation and hypogonadism. Nerve conduction study showed severe sensorimotor polyneuropathy. Serum immunofixation showed lambda light chain restricted monoclonal gammopathy. Bone marrow biopsy consistent with plasma cell dyscrasia. Hormonal assay showed decreased FSH, LH and estradiol levels which led us to diagnosis of hypogonadotrophic hypogonadism. The patient responded well to …

Attrition In School Rowing In New Zealand: A Qualitative Descriptive Study, Simon R. Walters, Rebecca Beattie, Anthony R. H. Oldham, Sarah-Kate Millar

The Qualitative Report

It is widely acknowledged that involvement in sport has positive physical and psychosocial benefits for adolescents. However, concerns have been expressed, both in New Zealand and internationally, about the relatively high attrition rates in youth sport. This qualitative study captured the experiences of eight (five male, three female) adolescents who were no longer participating in high school rowing programs in New Zealand. Data were gathered through semi-structured interviews, and we conducted an inductive thematic analysis. A secondary analysis was then conducted using a self-determination and basic psychological needs framework that placed specific emphasis on need satisfaction and need thwarting. Key …

Elderly Women’S Experience Of The Role Of Hydrotherapy In Health: Content Analysis, Parand Pourghane

The Qualitative Report

Living to an old age is considered by many elderly women to bring about a decreased quality of life. Hydrotherapy allows individuals to engage in certain physical activities that cannot be done outside the water. The purpose of this study was to explore elderly women’s experience of the role of hydrotherapy in their health and was conducted in selected pools of Guilan province in Iran in 2015-2016. Twenty-three elderly women were selected using a purposeful sampling strategy. The data was gathered through semi-structured interviews; Researchers used a qualitative design, based on a content analysis approach. Analysis results were identified as …

Hyperoxia Causes Mir-34a-Mediated Injury Via Angiopoietin-1 In Neonatal Lungs., Mansoor Syed, Pragnya Das, Aishwarya Pawar, Zubair H. Aghai, Anu Kaskinen, Zhen W. Zhuang, Namasivayam Ambalavanan, Gloria Pryhuber, Sture Andersson, Vineet Bhandari

Department of Pediatrics Faculty Papers

Hyperoxia-induced acute lung injury (HALI) is a key contributor to the pathogenesis of bronchopulmonary dysplasia (BPD) in neonates, for which no specific preventive or therapeutic agent is available. Here we show that lung micro-RNA (miR)-34a levels are significantly increased in lungs of neonatal mice exposed to hyperoxia. Deletion or inhibition of miR-34a improves the pulmonary phenotype and BPD-associated pulmonary arterial hypertension (PAH) in BPD mouse models, which, conversely, is worsened by miR-34a overexpression. Administration of angiopoietin-1, which is one of the downstream targets of miR34a, is able to ameliorate the BPD pulmonary and PAH phenotypes. Using three independent cohorts of …

Medical Therapies For Motor Symptoms In Parkinson’S Disease, Conrad Musey, Vikram Shivkumar

Marshall Journal of Medicine

Parkinson’s Disease is the second most common neurodegenerative disorder in the aging population. It is associated with progressive loss of nigrostriatal dopaminergic neurons. Parkinsonism is a clinical syndrome that consists of motor and non-motor symptoms. It has been well described that many if not all of these deficits are associated with abnormalities related to the neurotransmitter Dopamine. This review is intended for primary care physicians who often establish the diagnosis and initiate Parkinson’s treatments. One challenge faced by the primary care physician is to decide the appropriate medication and starting dose. Often medications are used at very low doses or …

The Effects Of Obesity On Outcomes In Trauma Injury: Overview Of The Current Literature, Milad Modarresi, Brad Gillon, Javad Najjar Mojarrab, Rodrigo Aguilar, Zackary Dylan Hunter, Matthew Steven Schade, Jackie Sanabria, Rebecca Klug, Seth Adkins, Juan R. Sanabria

Marshall Journal of Medicine

Obesity has reached epidemic proportions and is now considered a chronic disease by the National Institute of Health (NIH) in the West. Its impact on trauma outcomes is of particular interest with several studies presenting conflicting information. The present overview suggests a strong association between obesity and injury severity, hospital length of stay (LOS), intensive care unit (ICU) admission, pattern of injury, rate of complications and mortality. The nature of the observations may relate to an underlying physiological state of the obese patient and its associated comorbidities with a constant heightened inflammatory state aggravated by the second hit on an …

Reducing Postoperative Opioids After Minimally Invasive Gynecologic Surgery With Multimodal Pain Control, Kevin D. White, William C. Wallace, Nadim Zgheib

Marshall Journal of Medicine

Introduction:

We evaluated the efficacy of a multimodal pain regimen that approaches pain control by utilizing different mechanisms of action. This novel protocol utilizing liposomal bupivacaine, acetaminophen, tramadol and oxycodone as needed in reducing the overall opioid use by patients after undergoing robotic-assisted total laparoscopic hysterectomy in an obese population that is heavily afflicted by the opioid epidemic.

Materials and Methods:

We conducted a retrospective study wherein a sample of 100 (50 multimodal group and 50 controls) were taken from 433 eligible cases conducted over a 1 year period. Patient medical records were evaluated for demographics, surgical characteristics, opioid type …

Predicting Adverse Outcomes In Chronic Kidney Disease Using Machine Learning Methods: Data From The Modification Of Diet In Renal Disease, Zeid Khitan, Anna P. Shapiro, Preeya T. Shah, Juan R. Sanabria, Prasanna Santhanam, Komal Sodhi, Nader G. Abraham, Joseph I. Shapiro

Marshall Journal of Medicine

Background: Understanding factors which predict progression of renal failure is of great interest to clinicians.

Objectives: We examined machine learning methods to predict the composite outcome of death, dialysis or doubling of serum creatinine using the modification of diet in renal disease (MDRD) data set.

Methods: We specifically evaluated a generalized linear model, a support vector machine, a decision tree, a feed-forward neural network and a random forest evaluated within the context of 10 fold validation using the CARET package available within the open source architecture R program.

Results: We found that using clinical parameters available at entry into the …

Contingency Management For Smoking Cessation In Pregnancy, Jacob Miller, Brady Reynolds, Courtney Crain, Hisham Keblawi, Lynne J. Goebel

Marshall Journal of Medicine

This pilot study examined the feasibility of applying Contingency Management (CM), where the woman receives financial compensation for abstinence from smoking. Eleven subjects were recruited from Marshall’s OB clinic for the program. CO levels were measured daily using online video recording. Quit rates were determined at the end of pregnancy. Birth outcomes were measured at delivery. 21 pregnant smokers from Marshall’s OB clinic were used as the control group. The results demonstrated a trend toward improved rates of smoking abstinence in CM participants as compared with the control group. Our study also showed a trend towards improved birth outcomes in …

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

Marshall Journal of Medicine

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

Sheehan’S Syndrome: It Is Time To Become More Proactive In Identifying This Disease, Yara E. Tovar, Waseem Ahmed, Madhulika Urella, Ayman H. Elkadry, Rodhan A. Khthir

Marshall Journal of Medicine

Sheehan’s syndrome typically occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. It is more common in underdeveloped countries, and is frequently diagnosed years after delivery due to its nonspecific signs and symptoms. Failure to lactate is a common initial symptom, while many women also report amenorrhea or oligomenorrhea. This article presents a 26-year-old female with a history of hypertension, who presented to the hospital for diarrhea, vomiting, and dizziness. Her blood pressure was 80/40 mmHg, requiring aggressive fluid resuscitation, after which it remained borderline. Further testing …

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

Marshall Journal of Medicine

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

Massive Inguinoscrotal Bladder Herniation With Calculi, And Bladder Outlet Obstruction, Stanley Zaslau

Marshall Journal of Medicine

Scrotal herniation of the bladder is a rare event and can be associated with bladder outlet obstruction, bladder infarction and renal impairment. This condition is also associated with a significant mortality rate. We present a case report of extensive scrotal cystocele involving 90% of the bladder in which the diagnosis was suggested by KUB, pelvic ultrasound, and pelvic CT imaging showing distorted bladder anatomy and the presence of several large bladder calculi.

Opioid Epidemic-- Is There An End In Sight?, Sean Loudin, Mehiar El-Hamdani, Mohammed Ranavaya

Marshall Journal of Medicine

No abstract provided.

Two Years Of Triumph: Bringing Rural Healthcare To A Global Audience, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

Science Alive, Allan Barraza, Ahjay Bhatia, Gwen Bui, Sophia Nguyen

Trick to the Treat of Internships and Research

No abstract provided.

The Austria Summer Biology Internship, Max Cedeno-Hahn, Laura Enzinna

Trick to the Treat of Internships and Research

No abstract provided.

Beginning Experiment: Nanoparticle Uptake In Arpe-19 Cells, Nitya Nunna

Trick to the Treat of Internships and Research

No abstract provided.

Practicum In Biology, Sarah Amaris

Trick to the Treat of Internships and Research

No abstract provided.

Cano Health Clinical Studies Internship Program, Stephanie Hernandez

Trick to the Treat of Internships and Research

No abstract provided.

Rumbaugh Goodwin Institute Of Cancer Research, Christopher Garcia

Trick to the Treat of Internships and Research

No abstract provided.

The International Human Cadaver Prosection Program, Wilford Miranda, Christopher Garcia

Trick to the Treat of Internships and Research

No abstract provided.

Cleveland Clinic Summer Scholars Program, Chethani Chitraacharige

Trick to the Treat of Internships and Research

No abstract provided.