Medicine and Health Sciences Commons^™

Inflammatory Arthritis And Mycobacterium Tuberculosis Infection: A Diagnostic And Management Challenge For Knee Arthroplasty In Endemic Areas, Obada Hasan, Riaz Hussain Lakhdawala, Vickash Kumar, Syed Faisal Mahmood, Shahryar Noordin

Section of Orthopaedic Surgery

Tuberculosis continues to be one of the most challenging health problems more prevalent in developing countries. Pakistan ranks 5th in tuberculosis prevalence among the high-burden countries. Prosthetic joint infection of the knee by acid fast bacilli is a rare and distressing complication, occurring in nearly 1% of primary joint arthroplasties requiring prolonged medical treatment and multiple surgeries. A recent publication extensively reviewed English literature from 1952 to 2016, and repor ted only 64 prosthetic joint infec tion with tuberculosis, of which 27 cases involved the knee. Tuberculosis is a global health problem adding to the challenges that arthroplasty surgeons face …

Mining For Specialized Metabolism Genes In Red Sea Brine Pool Prokaryotic Metagenomes For Antibacterial And Anticancer Activities, Laila Ziko

Theses and Dissertations

Antibiotic and anticancer drug resistance are current global health threats, thus new antibiotics and anticancer agents are required to treat the strains and cancers that are currently untreatable with the available drug spectrum. One way to search for new chemotherapeutics is to search nature, particularly metagenomes of un-cultured microbial communities. A subset of specialized metabolites (SMs) produced by microbes confer activities of pharmaceutical importance, such as antibacterial and anticancer effects, and are coded by specialized metabolism gene clusters (SMGCs) in the organisms’ genomes. We aimed to search for SMGCs in the metagenomes of Red Sea brine microbial communities by employing …

Correlation Of Trainees' Selection Scores With Their Subsequent Performance During Specialty Training In Anesthesiology, Aliya Ahmed, Rashida Ahmed

Department of Anaesthesia

Objective: To determine the correlation of trainee selection scores (TSS) with subsequent performance in anesthesiology trainees at a university hospital.
Study Design: Descriptive analytical study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from August 2016 to January 2017.
Methodology: Data were collected on 44 anesthesiology trainees completing their training between 2009 and 2015. TSS consisted of entrance test, final-year medical school scores, and interviews. Assessment included written tests, viva voce, and clinical assessment. Non-parametric Spearman rank correlation coefficient was computed to assess the relationship between scores.
Results: Weak correlation was found between TSS and overall assessment …

Use Of Novel Anthropomorphic Breast Ultrasound Phantoms For Radiology Resident Education, Jacinta Browne, Chris Gu, Robert Fazzio, Andrew J. Fagan, Donald Tradup, Nicholas Hangiandreou

Articles

Purpose: This study evaluated the training and assessment role of anthropomorphic breast ultrasound phantoms which simulated both the morphological and sonographic characteristics of breast tissue, including lesions, in a group of radiology residents at a large academic medical center. Methods: This was a prospective study involving 9 residents across all years (2^nd–4^th year) of a radiology residency program. Baseline assessments of all residents ability to detect and characterize lesions in P-I were carried out, followed by a two-hour teaching session on the same phantom. All residents underwent a post-training, final assessment on P-II to evaluate changes in …

“Little Tablets Of Gold”: An Examination Of The Psychological And Social Dimensions Of Prep Among Lgbtq Communities, Christina J. Sun, Kirsten M. Anderson, Kim Toevs, Dayna Morrison, Caitlin Wells, Christina Nicolaidis

OHSU-PSU School of Public Health Faculty Publications and Presentations

There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users’ experiences were shaped by multiple forms of stigma. Participants …

4-D Computational Modeling Of Cardiac Outflow Tract Hemodynamics Over Looping Developmental Stages In Chicken Embryos, Katherine Courchaine, Mackenzie J. Gray, Kaitlin Beel, Kent L. Thornburg, Sandra Rugonyi

OHSU-PSU School of Public Health Faculty Publications and Presentations

Cardiogenesis is interdependent with blood flow within the embryonic system. Recently, a number of studies have begun to elucidate the effects of hemodynamic forces acting upon and within cells as the cardiovascular system begins to develop. Changes in flow are picked up by mechanosensors in endocardial cells exposed to wall shear stress (the tangential force exerted by blood flow) and by myocardial and mesenchymal cells exposed to cyclic strain (deformation). Mechanosensors stimulate a variety of mechanotransduction pathways which elicit functional cellular responses in order to coordinate the structural development of the heart and cardiovascular system. The looping stages of heart …

Equalization Of Four Cardiovascular Risk Algorithms After Systematic Recalibration: Individual-Participant Meta-Analysis Of 86 Prospective Studies, Lisa Pennells, Stephen Kaptoge, Angela Wood, Mike Sweeting, Xinghui Zhao, Carlos J. Crespo, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.

Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination …

The Scoop, Vol. 5 Issue 11, February 2019, Health Sciences Library

Volume 5

Latest news and events from the Health Sciences Library in our monthly newsletter for February 2019.

Association Between Leptin, Obesity, Hormonal Interplay And Male Infertility, Sofia Amjaad, Mukhtiar Baig, Nida Zahid, Sundus Tariq, Rehana Rehman

Department of Surgery Docs

Male infertility is a major health problem worldwide. We investigated a possible association between leptin, obesity, hormonal interplay and male infertility. This cross-sectional study of 313 males (178 infertile and 135 fertile) was carried out in 2017. The subjects were categorised by body mass index (BMI) and body fat percentage (BF%) into normal weight, overweight and obese. Significantly higher levels of BMI and BF% (p-value < 0.001) and lower levels of FSH, LH, testosterone, and SHBG (p-value < 0.001) were found in infertile males. However, no significant difference was observed in leptin levels (p-value = 0.35). Leptin levels were significantly higher, and all the sex hormones were significantly lower (p-value < 0.001) in obese subjects, whereas according to BF% only leptin, FSH and SHBG were significantly different. Leptin showed a significant positive correlation with BMI and BF% (p < 0.001). A strong positive link to serum testosterone was found with age, FSH, and LH (p < 0.001) and a negative one with BMI and BF% (p < 0.001). In mutivariable anlaysis, after adjusting for the other covariates, a significant association between FSH and testosterone (p-value <0.001) was found. Serum leptin levels did not differ significantly in fertile and infertile groups, and no association was found with infertility. Furthermore, male obesity was found to be associated with infertility with the decrease in levels of sex hormones.

Oral Cancer Awareness Among University Students From Karachi, Pakistan, Dnyanesh Limaye, Patrick Ziesenis, Vaidehi Limaye, Mansoor Ahmad, Farah Saeed, Mahboob Alam, Ramla Rizvi, Atul Kapadi, Sushama Sathe, Gerhard Fortwengel

Section of Dental-Oral Maxillofacial Surgery

Background: Oral cancers (OC) are malignant lesions occurring in the oral cavity that include squamous cell carcinomas (SCC), salivary gland and odontogenic neoplasms. Even though it is the eighth most common malignancy globally but in Pakistan it is the second commonest type of cancer. Lack of awareness about ill-effects of preventable risk factors of oral cancer increases the burden of disease due to the associated high cost of treatment, permanent impairment and high mortality. Hence, awareness can be very helpful in prevention, control and early diagnosis of oral cancer.
Methods: A cross-sectional study was carried out among university students from …

Severity Of Disease And Mortality For Hospitalized Patients With Community-Acquired Viral Pneumonia Compared To Patients With Community-Acquired Bacterial Pneumonia, Richard Y. Kim, Thomas Chandler, Stephen P. Furmanek, Timothy Lee Wiemken, Rodrigo Cavallazzi

The University of Louisville Journal of Respiratory Infections

Background: There exists a large body of literature to help identify, diagnose, treat, and manage community-acquired pneumonia (CAP). Despite this, there is little data that directly compares the clinical syndromes and complications of pure bacterial pneumonia to pure viral pneumonia. Our study compares the clinical presentation, morbidity and mortality of viral vs. bacterial etiologies of CAP.

Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) international study database. Data was collected concerning patient demographics, physical examination findings, laboratory findings, radiological findings, severity of illness, and clinical outcomes and stratified according to the two study groups, CAVP …

Carbapenem-Resistant Enterobacteriaceae Infections: A Review Of Epidemiology And Treatment Options, Julie Harting

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Are We Doing It For The Money? A Salary Survey Of The United States Surgical Program Directors, Alexander Hoey, Ba, Brian Hoey, Md, Stanislaw Stawicki, Md

Phase 1

Compensation packages and job responsibilities for United States surgical program directors (PD) vary considerably from one institution to the next. With limited compensation data available for PD’s, this survey reassesses and compares the salaries, benefits, duties, and contract arrangements of all allopathic U.S. surgical PDs. Questionnaires regarding these areas of interest were mailed out electronically to all of the PDs and data was compared between the individuals’ responses using Chi-Squared and Fischer Exact Tests. Fifty-five percent of the PDs responded, revealing significant variation in total compensation packages, size of the dedicated stipend for the role, and time spent on clinical …

A Multicomponent Quality Improvement Project To Improve Sleep In Hospitalized Patients: A Single Center Pilot Experience, Michelle Konkoly, Alan Kubey, Md

Phase 1

No abstract provided.

A Qualitative Evaluation Of The Interprofessional Student Hotspotting Learning Collaborative: Perceptions Of Student And Faculty Advisor Participants, Ashley Traczuk, Bsn, Rn, Angela Gerolamo, Phd, Rn, Elena Umland, Pharmd

Phase 1

Introduction: Student participation in interprofessional education has proven beneficial in regards to students’ understanding of professional roles, team situational awareness¹,and appreciating the need for collaboration². The interprofessional student hotspotting learning collaborative enables students to work in teams to help serve patients categorized as health-system “super-users”, defined as those who overuse inpatient and/or emergency hospital services, over a period of six months’ time. This model will allow students to have real patient encounters and to begin utilizing their own roles within interdisciplinary teams.

Objective: This study aims to evaluate the impact of the interprofessional student hotspotting learning …

Total Body Skin Exam And Number Needed To Screen, Audra Hugo, Michael Bui, Alexander Sherban, Shayan Waseh, Elizabeth Jones, Md

Phase 1

Introduction/Background: Skin cancer screening could impact mortality and morbidity in US adults; however, the effectiveness of widespread screening remains unclear. Further research is necessary to determine what age groups, with what risk factors, might benefit from routine total body skin exams (TBSE) in the US.

Objective: This study sought to determine, on average, the number of patients, per decade, needed to screen via TBSE to identify one person with skin cancer.

Methods: A retrospective review of Jefferson Dermatology outpatient data in Epic was conducted. All patient charts from 1/1/2017 - 1/1/2018 were reviewed if they received a TBSE. The type …

Outcomes Reporting In Regional Anesthesia Patients: A Comparison Of Manual Phone Calls Versus Automated Phone App Messaging, Gavyn Ooi, Mba, Eric Schwenk, Md, Fasa, Jeffrey Mojica, Do, Alexander Grant, Md, Max Shilling, Md, David Barnabei, Md, Jennifer Lessin, Ba, Rn, Ccrc, Marc Torjman, Phd, Kent Berg, Md, Mba

Phase 1

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure.

As part of normal follow up, anesthesia team …

Mindfulness-Based Stress Reduction Intervention For The Treatment Of Chronic Pain In The Elderly, Austin Roadarmel, Diane Reibel, Phd, Aleeze Moss, Phd, Andrew Newberg, Md

Phase 1

One of the most common complaints of adults in their 80s and above, a growing portion of our population, is chronic pain and it is often inadequately treated. A secular mindfulness-based stress reduction (MBSR) program was developed by Jon Kabat-Zinn in 1979 and has since shown measurable benefits to individuals in decreasing depression, pain, and anxiety. Considering the significant risk of side effects and age-associated changes of pharmacodynamics and pharmacokinetics in the traditional pharmacologic approach to chronic pain in the elderly, non-pharmacologic intervention such as MBSR may be particularly effective for the elderly population.

Methods: We conducted a 6 week, …

Comparison Of Visual Analog Pain Score Reported To Physician Vs Nurse In Nonoperatively Treated Foot And Ankle Patients, Trevor Mcbride, Bs, Maj Kevin D. Martin, Do, Cpt Jeffrey Wake, Do, Atc, Lt J. Preston Van Buren, Do, Cuyler Dewar, Bs

Phase 1

Background: Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as health care seeks to define treatment outcomes. The Visual Analogue Scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in nonoperative patients. We hypothesize that patients’ VAS scores reported to the surgeon and a nurse will be the same

Methods: This study is a retrospective cohort of 201 consecutive nonoperative patients treated …

Impact Of Patient Safety Bundle For Management Of Morbidly Adherent Placenta On Estimated Blood Loss, Aislinn Crank, Johanna Quist-Nelson, Md, Arbor Quist, Msph

Phase 1

Introduction: Establishment of centers of excellence for care of patients with morbidly adherent placentas (MAP) has been described to improve patient outcomes. We compared maternal estimated blood loss (EBL) for patients with MAP delivered before and after the implementation of a protocol for management of MAP.

Objective: To assess the impact of a new protocol for management of MAP.

Methods: This is a retrospective cohort of patients at TJUH who had a MAP between 2007 and 2018. In 2015 our center developed a protocol as a patient safety bundle for the management of MAP. Pre-protocol and post-protocol groups were compared. …

Sickle Cell Disease And Variation In The Par4 Receptor, Matthew Lankiewicz, Steven E. Mckenzie, Leonard Edelstein, Stephanie Renna

Phase 1

Sickle cell disease disproportionately affects African Americans in the U.S. Much can still be learned regarding determinants of frequency and severity of painful vaso-occlusive episodes in these patients. It has been reported that a variant in PAR4 (protease-activated receptor 4) has a unique distribution among African Americans. One variant (Thr120) is hyperactive, while the other (Ala120) is hypoactive. This receptor is present on platelets, vascular cells, and nociceptors. We wish ultimately to test the hypothesis that sickle cell patients with the hyperactive PAR4 receptor have greater pain severity. A genotype-phenotype correlation would have prognostic value. An adequately powered study to …

Treatment Outcomes In Gram Negative Periprosthetic Joint Infection, Irene Kalbian, Ba, Karan Goswami, Md, Carol Foltz, Phd, Nathan John, Bs, William Arnold, Md, Javad Parvizi, Md, Fcrs

Phase 1

Introduction: Outcomes associated with periprosthetic joint infection (PJI) involving Gram negative (GN) organisms are poorly understood. While prevailing beliefs indicate that GN PJI cases have poorer prognoses than Gram positive (GP) cases, the current literature is sparse and inconsistent.

Objective: The purpose of this study is to systematically compare the treatment outcomes for GN PJI versus GP PJI.

Methods: A retrospective review of 1189 PJI cases between 2007 and 2017 was performed using an institutional PJI database. Treatment failure defined by the Delphi criteria was compared between cases with only GN organisms (n=45) and only …

Investigating Gαs Pepducin’S Effect On Β2ar Signaling For Chf Pharmacology, Nida Bajwa, Nathan Hopfinger, Charles Scott

Phase 1

Introduction: Congestive heart failure affects nearly six million Americans and significantly impairs their quality of life. New and better interventions are needed to improve HF patients’ survival and outcomes. Pharmacologics that bias β2AR signaling towards arrestin, which promotes cardiomyocyte survival and contractility, may offer advantages over traditional β-blockers.

Objective: It has been demonstrated that peptides mimicking the C-terminus of the Gα_s subunit block downstream signaling of GPCRs. The study’s objective is to determine if a pepducin derived from the C-terminus of the Gα_s subunit of the β2AR could block G_s signaling but maintain arrestin-recruitment, thereby producing a …

The Pathway To Low Outlier Status In Venous Thromboembolism Events: An Analysis Of Pancreatic Surgery In Acs Nsqip, Samantha L. Savitch, Tyler M. Bauer, Nikosi H. Alvarez, Adam P. Johnson, Theresa P. Yeo, Harish Lavu, Charles J. Yeo, Jordan M. Winter, Geno J. Merli, Scott W. Cowan

Phase 1

Introduction: Our institution’s hepatopancreaticobiliary service (HPBS) is a high-volume pancreatic surgery service, which has demonstrated consistently low rates of symptomatic venous thromboembolism (VTE) compared to similar institutions as reported by NSQIP. We sought to determine if the HPBS’s regimented multimodal VTE prophylaxis pathway plays a role in achieving consistently low VTE rates.

Methods: We queried the ACS NSQIP Participant User File and our institution’s data from 2011-2016 for major pancreatic operations. We used Chi-squared analysis to compare the HPBS and national patient populations, and created a matched dataset based on preoperative patient factors. Univariate and multivariate analyses were performed on …

Long Term Effects Of Ovum Donation On Donors, Danielle Garfunkel, Andrea Braverman

Phase 1

Introduction: As infertility affects 17% of couples, IVF has become a key, increasingly prevalent option for couples with oocyte donors providing eggs to infertile women in ~13.7% of IVF cycles. Despite the growing prevalence of donation, there are no long-term follow up studies on the emotional and health effects of donation. We cannot appropriately counsel patients regarding the risks of the donation procedure without understanding its effects.

Objective: This study sets out to identify the long-term effects of oocyte donation on donors’ mental state and physical health and how the attitudes and concerns of oocyte donors regarding their donation …

Implementation Of Psychological Interview And Testing In A Large Sperm Bank, Catherine Sham, Andrea Braverman, Robert Mora, Makenzie Perdue, Jaime Shamonki

Phase 1

Introduction: Historically, sperm donor applicants have been medically but not psychologically evaluated by mental health professionals (MHPs). As social norms and legislation shift toward non-anonymous donation, psychological assessments can provide opportunities to exclude unqualified donors and allow donors to consider the long-term implications of donating.

Objective: To determine the effectiveness of psychological screening in identifying unqualified sperm donors, and to evaluate psychological reasons for disqualification through clinical interview and testing.

Methods: A retrospective chart review of 229 potential donors who passed initial qualification at a major sperm bank from February 2017 to February 2018. All potential donors were evaluated by …

Technology Use And Wellness Maintenance In A Medical Student Population, Lillian Flashner

Phase 1

Introduction: Burnout now affects more than half of U.S. medical students, causing decreased resilience and coping ability. When these students become physicians, they are more likely to commit medical error and have decreased patient satisfaction. Studies in college students have shown that technology use may improve wellness and deter burnout; however, heretofore no studies have been conducted to understand if medical students use the same practices.

Objective: Our specific aims were to survey medical students to identify whether they use technology to maintain their wellness, and to identify which technologies are the most effective for this purpose.

Methods: We distributed …

Assessing The Operative Log Data Of Traditional (5+2) Vs. Integrated (0+5) Vascular Training Programs, Ernest Gillan, Bs, Anthony Feghali, Md, Tuong Nguyen, Md, Dawn Salvatore, Md, Paul Dimuzio, Md, Babak Abai, Md

Phase 1

Introduction: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5 year vascular surgery residency program. Operative experience can be used as a surrogate marker for success in the evolving field of vascular surgery training.

Objective: The purpose of this study is to compare the operative experience of those graduating from the traditional (5+2) vascular training program with the integrated (0+5) program.

Methods: National operative case log data supplied by the ACGME was gathered and organized for vascular surgery residents graduating between 2013 and 2018. Mean case numbers were compared between integrated vascular residents and traditional …

An Evaluation Of Ultrasound-Guided Regional Block Anesthesia In Outpatient Hand Surgery, Daniel Calem, Armen C. Voskeridjian, Md, Michael Rivlin, Md, Pedro Beredjiklian, Md, Mark L. Wang, Md, Phd

Phase 1

Introduction: The utilization of ultrasound-guided peripheral nerve blocks in orthopedic surgery has increased in popularity as the anesthesia of choice for the management of perioperative pain. Peripheral nerve blockade has been shown to increase overall surgical efficiency, improve patient satisfaction, reduce postoperative narcotic use, and decrease the duration of facility admissions, while increasing overall cost-effectiveness. To date, scant literature exists regarding the safety and efficacy of ultrasound-guided supraclavicular blocks used in common hand surgery procedures, and the rate of neurologic and vascular complications remains unknown.

Objective: The purpose of this study was to examine the effectiveness and complication rate of …

Roles For The Uptake2 Transporter Oct3 In Regulation Of Dopaminergic Neurotransmission And Behavior, Paul J. Gasser

Biomedical Sciences Faculty Research and Publications

Transporter-mediated uptake determines the peak concentration, duration, and physical spread of released monoamines. Most studies of monoamine clearance focus on the presynaptic uptake₁ transporters SERT, NET and DAT. However, recent studies have demonstrated the expression of the uptake₂ transporter OCT3 (organic cation transporter 3), throughout the rodent brain. In contrast to NET, DAT and SERT, OCT3 has higher capacity and lower affinity for substrates, is sodium-independent, and is multi-specific, with the capacity to transport norepinephrine, dopamine, serotonin and histamine. OCT3is insensitive to inhibition by cocaine and antidepressant drugs but is inhibited directly by the glucocorticoid hormone corticosterone. Thus, …