Medicine and Health Sciences Commons^™

A Phantom Of The Past: Withdrawal From Meprobamate Presenting With Focal Seizures., Thomas M. Zink, John E. Erickson

Journal of Maine Medical Center

Introduction: Meprobamate (Miltown, Equinil) is a sedative-hypnotic medication that first gained popularity as an anxiolytic and later as a muscle relaxant. It is a major metabolite of the more commonly used muscle relaxant carisoprodol (Soma). In vitro and electroencephalogram studies demonstrated that meprobamate modulates gama-aminobutyric acid (GABA) receptors, similar to barbiturates. Withdrawal from meprobamate manifests in symptoms ranging from mild anxiety to severe autonomic instability and death. Meprobamate is rarely prescribed, but is still given to a small subset of elderly patients.

Clinical findings: In this case of meprobamate withdrawal, the patient initially displayed altered mental status and recurrent seizures …

Toxic Leukoencephalopathy Presenting As Agitation And Social Withdrawal In A Patient With Substance Use Disorder: A Case Report, Andrew R. Beauchesne, Brian F. King

Journal of Maine Medical Center

Introduction: Toxic leukoencephalopathy (TLE) is characterized by damage to myelin of cerebral white matter and is caused by a number of offending agents, including drugs of abuse. The clinical presentation of TLE is variable and not fully understood.

Clinical Findings: A 51-year-old male presented with pneumonia, parapneumonic effusion, and acute kidney injury. His medical course was complicated by neurobehavioral changes, including aggression and social withdrawal.

Diagnoses, interventions, and outcomes: The patient was diagnosed with acute toxic leukoencephalopathy based on diffuse subcortical T2-weighted-fluid-attenuated inversion recovery (T2/FLAIR) on brain MRI, bilateral frontal arrhythmic delta waves on encephalogram, and a …

Small Cell Lung Cancer Presenting With Personality Change, Brian F. King, Heidi Horstman, Katherine Rizzolo

Journal of Maine Medical Center

Introduction: Paraneoplastic limbic encephalitis is a syndrome characterized by autoimmune inflammation of the limbic system in the setting of underlying malignancy. The syndrome presents with acute to subacute neuropsychiatric clinical findings, often before the cancer diagnosis is known.

Clinical Findings: A 57-year-old woman with a 30 pack-year smoking history presented to Maine Medical Center after multiple generalized tonic-clonic seizures. Her family reported periodic odd behavior including confusion, disinhibition, and paranoia--all of which preceded her first seizure by two weeks.

Diagnoses, interventions, and outcomes: MRI brain showed T2/FLAIR signal hyperintensity of the right amygdala and hippocampus with sparing of the right …

Fresh Fruits And Vegetables Really Do Keep The Doctor Away: Symptomatic Vitamin Deficiency In A Middle Aged Man, Matthew J. Turnquist Md, Christina Holt Md, Msc

Journal of Maine Medical Center

Introduction

We present a clinical case of symptomatic vitamin deficiency typically seen only in resource limited environments or alcoholics, presenting in an adult male with frequent oral intake, but limited diet of prepared foods, as well as co-occurring pernicious anemia.

Clinical Findings

The patient presented with complaints of ascending paresthesia leading to near syncope, lower extremity edema and hyperpigmentation on his anterior legs bilaterally which had been present for years.

Diagnosis and interventions

He was found to have mixed B12, thiamine, and folate deficiency. These were attributed to a combination of nutritional deficiency due to a diet of exclusively cooked …

Introducing An Adult Adhd Toolkit For Application In Collaborative Care, C. Jason Mallo

Journal of Maine Medical Center

Introduction: While providers in collaborative care have been challenged to respond to rising patient complaints about attention deficit hyperactivity disorder (ADHD) in adulthood, institutional guidance has been lacking or insufficient. To address this issue, an Adult ADHD Toolkit was created to be used by providers spanning primary care and psychiatry. This article reviews how the toolkit was developed, its contents, and future directions.

Methods: A workgroup of providers from different backgrounds devised materials for the toolkit by reviewing adult ADHD literature and clinical consensus.

Discussion: The toolkit addresses common dilemmas encountered in the evaluation and management of adult ADHD, and …

Northern New England Clinical And Translational Research Network Assesses The Training Needs Of Investigators, Brenda M. Joly, Fleur Hopper, Carolyn Gray

Journal of Maine Medical Center

INTRODUCTION

The Northern New England Clinical and Translational Research (NNE-CTR) Network was created to enhance the region’s research capacity and infrastructure. The NNE-CTR provides research design consultation and technical assistance, research technologies support, professional development opportunities and mentorship, as well as funding for pilot projects. This study sought to describe the characteristics of NNE-CTR investigators and to identify their research interests, training needs, and perceived barriers to research.

METHODS

A registration survey and 13-item needs assessment module were developed and administered to capture data on the characteristics, background, and research-related training needs, interests and barriers among investigators in Maine, New …

Changes In Hospital Utilization By Individuals Experiencing Homelessness After Engaging With Interdisciplinary, Low-Barrier Healthcare Services In Portland, Maine, Sarah Hemphill Ba, Adam Normandin Md, Ms, Debra Rothenberg Md, Phd

Journal of Maine Medical Center

Introduction: The Maine Medical Center Preble Street Learning Collaborative (PSLC) aims to couple medical education with addressing the unmet healthcare needs of those experiencing homelessness in Portland, Maine. The PSLC provides low-barrier medical, psychiatric, dental, and case management services to all-comers and is co-located near many of the city’s social services. The purpose of this study was to evaluate the impact of the PSLC in its first 19 months by describing demographic characteristics and patterns in hospital utilization of patients served by the PSLC.

Methods: We performed a retrospective chart review of 888 patients with one or more …

Virtual Coaching And Deliberate Practice To Enhance Medical Students' Clinical Reasoning During Oral Case Presentations, Nicole Akar-Ghibril Md, Cristina Carter Md, Gabrina Dixon Md, Med, Ellen Goldman Med, Mba, Mary C. Ottolini Md, Mph, Med

Journal of Maine Medical Center

ABSTRACT:

Introduction

Oral case presentations (OP) provide an opportunity for medical students to practice clinical reasoning and communication skills, and for faculty to provide assessment. Specific teaching strategies are needed to improve students’ OP skills.

Objective

To compare the effectiveness of Virtual Coaching (VC) to Small Group (SG) discussion or Traditional Feedback (TF/control) in improving clinical reasoning during OP, using a validated PBEAR (Problem Representation, Background Evidence, Analysis, Recommendation) tool.

Design/Methods

Students from two medical schools were randomly assigned to three groups during their inpatient pediatric clerkship. All completed an eLearning module about using illness scripts to promote clinical reasoning …

End-Of-Life Healthcare Use Of Medicare Patients With Melanoma Based On Patient Characteristics And Year Of Death, Rebecca N. Hutchinson, F. Lee Lucas, Kathleen Fairfield

Journal of Maine Medical Center

Background: Many cancer patients receive overly-intensive care at end-of-life (EOL), despite recognition that this is a marker of poor quality. There is limited knowledge about care received by patients dying with melanoma.

Objective: We characterized healthcare utilization during EOL and patient characteristics associated with variations in care. We also described how utilization changed over time.

Methods: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify 9099 melanoma patients aged 65+ at diagnosis between 2000 and 2009, who died by 12/31/2010. We included patients enrolled in Medicare part A and B six-months prior to diagnosis and not in managed …

Time To Bring Curiosity Back Into The Practice Of Medicine, Robert Bing-You

Journal of Maine Medical Center

No abstract provided.

Medical School Watercooler Newsletter - January 5, 2020, Lindsey Lyle

Watercooler Newsletter

This is the January 5, 2020 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• Mark Your Calendar: Upcoming grand rounds
• Muslims in Medicine interest group addresses physician burnout
• USA Health and USA College of Medicine represented in Mobile Bay’s 40 Under 40
• Student-Run Free Clinic makes an impact in 2019

Response By Endodontists To The Sars-Cov-2 (Covid−19) Pandemic: An International Survey, Johnah C. Galicia, Rahma Mungia, Melanie V. Taverna, Marissa J. Mendoza, Carlos Estrela, Alexis Gaudin, Chengfei Zhang, B. A. Vaughn, Asma A. Khan

Pacific Faculty Work

As SARS-CoV-2 continues to wreak havoc, health care workers are on the front lines to protect our communities. Dentists, particularly endodontists who manage dental emergencies, are engaged in high risk procedures that necessitate the modification of their treatment strategies in order to protect themselves, their staff and their patients from exposure to SARS-CoV-2. This study gathered international data from 448 endodontists to describe their awareness, their clinical care modifications, their strategies for re-opening and their reflection on the effects of the pandemic on their lives. Most endodontic practitioners (78%, n = 350) provided but limited their treatments to emergency care …

Key Regeneration-Free Ciphertext-Policy Attribute-Based Encryption And Its Application, Hui Cui, Robert H. Deng, Baodong Qin, Jian Weng

Research Collection School Of Computing and Information Systems

Attribute-based encryption (ABE) provides a promising solution for enabling scalable access control over encrypted data stored in the untrusted servers (e.g., cloud) due to its ability to perform data encryption and decryption defined over descriptive attributes. In order to bind different components which correspond to different attributes in a user's attribute-based decryption key together, key randomization technique has been applied in most existing ABE schemes. This randomization method, however, also empowers a user the capability of regenerating a newly randomized decryption key over a subset of the attributes associated with the original decryption key. Because key randomization breaks the linkage …

Study Of Cost Utilization Of Organophosphate And Zinc Phosphide Poisoning: A Prospective Observational Study, Girish P. Thunga Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Introduction and Aim: Pesticides and rodenticides have been useful for killing pests and rodents respectively but at the same time proven to be harmful to humans as well. They are easily available and accessible to the common people due to which they are often misused for self-harm predominantly in developing countries. There is a lot of burden on the healthcare system due to limited healthcare resources. This study aims to estimate the various costs incurred by the patients during the complete hospitalization period. Methodology: A prospective observational study was conducted in a tertiary care hospital. The patient related data was …

To Study The Treatment Pattern Of Paraquat Poisoning In A Tertiary Care Hospital: A Retrospective Analysis, Girish P. Thunga Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Introduction Paraquat poisoning is a major medical problem in many parts of Asia, Pacific nations, and America [1] . It is rapidly-acting, nonselective and relatively inexpensive due to which widespread use in the developing world is.An increased rate of morbidity and mortality is associated with Paraquat poisoning. General treatment includes gastrointestinal decontamination like treatment with activated charcoal and fuller's earth given to minimize the absorption Haemodialysis and Hemoperfusion also plays important role for elimination of poison. Immunosuppression is also widely practised with Dexamethasone, Cyclophosphamide and Methylprednisolone. Many evidences showed antioxidants such as N-Acetylcysteine also beneficial. However, there are no clear …

Effect Of Metformin In Wound Healing In Diabetic Foot Ulcer Patients –A Prospective Observational Study, Sonal M. Sekhar Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: Diabetic foot ulcers (DFUs) are one of the major complications of poorly controlled diabetes. The DFUs result due to the damage and breaking of the skin beneath it. The most commonly affected locations of DFUs are the extreme proximities of the toes. The wounds associated with foot ulcerations are the leading causes of the leg amputation. Metformin, a widely used anti- diabetic agent has a vital role in AMPK activation as well as plays an inhibitory effect on the mTOR, and Cyclin D1 pathways. Thereby causing a delay in the usual process of healing of wound in the patients. …

Evaluation Of Antimicrobial Agents With Potential To Develop Adverse Mental Health In Geriatrics, Sonal M. Sekhar Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: With advanced age, there is increased risk of various infections. Antimicrobial agents are majorly prescribed for management of these infections. Due to age-related physiological changes, many of the antimicrobial agents cause adverse mental health. Therefore, we evaluated the geriatric antimicrobial prescription to determine its potential to cause mental health issue. Objectives:  To prepare a checklist for antimicrobials which have the potential to cause adverse mental health.  Evaluate the geriatric antimicrobial prescription to determine its potential to cause mental health issue.  To determine antimicrobial-related mental health problems in geriatric patients. Methods: A prospective observational study was conducted …

Effectiveness Of Pictograms In Patients Or Caregivers In Healthcare Settings: A Systematic Review, Rajesh V Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: Pictograms are a graphical symbol that conveys a concept through its pictorial resemblance to a physical object, pictorial representation has shown to have a potential in enhancing patient knowledge. Methodology: The systematic review was conducted according to PRISMA guidelines. Randomized controlled trials including participants over 18 years older were included in the review. RCTs were included as it reduces certain type of bias by randomly allocating the participants. The risk of bias was assessed using Cochrane risk of bias tool, which assessed 5 different domains and scores were given according to their indication of low, high and unclear risk. …

Potential Drug- Drug Interactions Between Anti- Tumor Agents And Other Prescribed Medications In Lung Cancer Patients: A Retrospective Study, Mahadev Rao Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: Cancer patients are more prone to drug interactions as multiple medications are administered concomitantly along with cytotoxic agents in addition with drugs targeted to treat underlying comorbidities, and these are poorly evaluated. In the challenging field of cancer where the number of patients diagnosed increases in a geometric manner, the difficulties faced by healthcare professionals to treat the patients poses a great deal of arduous task in designing an optimum therapeutic regimen. This study addresses the current dilemma and suggests to bring about a resolution to the existing problem. Objectives: The primary objective of this study is to characterize, …

Study Of Drug Related Problems In Type Ii Diabetes Mellitus Patients With Comorbidities In A Tertiary Care Hospital -A Retrospective Study, Leelavathi D. Acharya Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

IntroductionDiabetes Mellitus is a metabolic disorder characterised by high sugar level over a prolonged period of time. It is associated with the developing of complication due to a number of factors like the degree of vulnerability, susceptibility, age, health status and immune system condition.(1) Patients with Diabetes Mellitus along with morbidities receiving medications lead to different Drug related problems like polypharmacy, drug-drug interaction, adverse drug reactions etc.ObjectivesTo assess the Drug related problems in Type 2 Diabetes Mellitus patients with comorbidities using PCNE classification and Hepler Strand classification in a tertiary care hospital in South India.Methodology A retrospective observational study conducted …

Physiologically Based Pharmacokinetic Modelling Of Aminophylline And Caffeine, Surulivelrajan Mallayasamy Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: Irregularity in temperature regulation and control of breathing during the first few days are the reasons for the abrupt deaths in preterm neonates, of which apnea in premature neonates constitutes the major reason for these deaths. Methylxanthine’s (aminophylline and caffeine) are used in its treatment. Majority of the hospitals follow a standard treatment regimen for both aminophylline and caffeine irrespective of preterm’s age and body weight which leads to toxic or sub-therapeutic concentrations of the drug. Using Physiologically based pharmacokinetic modelling (PBPK), various drug characteristics and its deportment can be studied. This helps in predicting the Pharmacokinetic parameters of …

Prevalence And Factors Influencing Inappropriate Medication Use In Elderly Patients - A Retrospective Study Using Updated Beers Criteria, Sreedharan Nair Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: A major safety concern in elderly population is the use of inappropriate medication. Owing to aging associated with anatomic and physiologic changes, pharmacokinetic and pharmacodynamics of drugs are prone to alter in these elderlies. Inappropriate drug prescribing and polypharmacy in this population elevates the risk of adverse drug reactions. Objectives: To assess the prevalence and factors influencing Potentially Inappropriate Medication (PIM) use in elderly patients according to updated Beers Criteria. Methodology: A retrospective observational study was carried out. Case records of 580 patients aged 65 years and above were reviewed. Every case record was identified for at least one …

Prenatal Choline Supplementation During High-Fat Feeding Improves Long-Term Blood Glucose Control In Male Mouse Offspring, Hunter W. Korsmo, Kaydine Edwards, Bhoomi Dave, Chauntelle Jack-Roberts, Huanling Yu, Anjana Saxena, Marie Salvador, Moshe Dembitzer, Jaskomal Phagoora, Xinyin Jiang

Publications and Research

Maternal obesity increases the risk of metabolic dysregulation in rodent offspring, especially when offspring are exposed to a high-fat (HF), obesogenic diet later in life. We previously demonstrated that maternal choline supplementation (MCS) in HF-fed mouse dams during gestation prevents fetal overgrowth and excess adiposity. In this study, we examined the long-term metabolic influence of MCS. C57BL/6J mice were fed a HF diet with or without choline supplementation prior to and during gestation. After weaning, their pups were exposed to either a HF or control diet for 6 weeks before measurements. Prenatal and post-weaning dietary treatments led to sexually dimorphic …

Prevalence Of Sensorineural Hearing Loss In Children With Palliated Or Repaired Congenital Heart Disease., Lalitha Gopineti, Mane Paulpillai, Andrea Rosenquist, Andrew H. Van Bergen

Manuscripts, Articles, Book Chapters and Other Papers

Background Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental deficits, and the presence of sensorineural hearing loss (SNHL) may further lead to poor language skills acquisition and speech delays. Prevalence of SNHL in the general pediatric population is estimated to be 0.2% at birth to 0.35% during adolescence. Very few studies have attempted to estimate SNHL prevalence in children who have undergone congenital heart surgery. Methods This retrospective study aimed to estimate SNHL prevalence in children who underwent congenital heart surgery in our institution and were followed up in our high-risk pediatric cardiology clinics for four …

Geospatial Variation In Caesarean Delivery, Jennifer Vanderlaan, Johnathan A. Edwards, Anne Dunlop

Nursing Faculty Research

Aim: The purpose of this study was to evaluate the variation in caesarean delivery rates across counties in Georgia and to determine whether county-level characteristics were associated with clusters. Design: This was a retrospective, observational study.

Methods: Rates of primary and repeat caesarean by maternal county of residence were calculated for 2008 through 2012. Global Moran's I (Spatial Autocorrelation) was used to identify geographic clustering. Characteristics of high and low-rate counties were compared using student's t test and chi squared test.

Results: Spatial analysis of both primary and repeat caesarean rate identified the presence of clusters (Moran's I = 0.375; …

Attitudes Towards Mental Illness In American Evangelical Communities, Supernaturalism, And Stigmatization, Nahanni Freeman, Isaac Baldwin

Faculty Publications - Psychology Department

Social-cognitive variables and religious attributions regarding mental illness were examined with a homogeneous sample of 180 American Evangelical Christians, using a novel tool and the Mental Health Knowledge Scale (MAKS). In the first trial, participants were randomly assigned to one of two Bible verse priming conditions, which made salient willpower, faith and anxiety-reduction or the suffering Christ. Priming effects revealed that those exposed to the willpower-faith admonishment condition showed lower stigma on the MAKS and stronger condition recognition scores. Participants who endorsed unilateral religious causes and solutions to mental illness also presented with less knowledge about mental health disorders and …

To Study Disease Activity And Various Counseling Techniques In Rheumatoid Arthritis Patients, Kanav Khera Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: Education and counseling creates awareness amongst RA patients regarding the nature of their disease, drugs and lifestyle. Often, early diagnosis of RA prevents permanent disability. However, this does not happen in many cases. With the intention of coping with RA related complications and promoting healthy living, this study assessed the importance of counseling interventions with the aid of patient information leaflets and digital media as an adjunct for better patient care. Objectives: To study three counseling interventions, drug utilization, disease activity and quality of life in Rheumatoid Arthritis patients. Methods: A prospective study was conducted where 30 patients were …

To Study Drug Utilization And Qol In Patients With Bronchial Asthma, Kanav Khera Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background: Bronchial Asthma (BA) is a chronic inflammatory of the airways.[1] It is generally known that asthma can cause an impact on a patient’s Quality of Life (QoL), mostly in a negative manner. To perceive the impact it has on the population, ‘Questionnaires on Quality of Life’ in asthmatic patients were made. Improving the QoL of patients with asthma mainly aims at reducing the risk of exacerbation and preventing morbidity related to asthma. Drug Utilization studies are important in order to assess the current prescription patterns against standard guidelines and can help in rationalizing the management. The economic burden of …

Implementing Routine Communication About Costs Of Cancer Treatment: Perspectives Of Providers, Patients, And Caregivers, Marie Haverfield, A. E. Singer, C. Gray, A. Shelley, A. Nash, K. A. Lorenz

Faculty Publications

Objectives Rising costs in oncology care often impact patients and families directly, making communication about costs and financial impacts of treatment crucial. Cost expenditures could offer opportunities for estimation and prediction, affording personalized conversations about financial impact. We sought to explore providers’, patients’, and caregivers’ preferences towards implementing communication about cost, including when, how, and by whom such information might be provided.

Methods We conducted semi-structured phone interviews with a diverse population including 12 oncology providers, 12 patients, and 8 patient caregivers (N = 32). The constant comparative method was used to identify mutually agreed upon themes.

Results Participant groups …

Endoscopic Rhizotomy For Chronic Lumbar Zygapophysial Joint Pain., Yuntao Xue, Tao Ding, Dajie Wang, Jianli Zhao, Huilin Yang, Xiaofeng Gu, Dehong Feng, Yafeng Zhang, Hao Liu, Fenglin Tang, Wanyi Wang, Miao Lu, Chao Wu

Department of Anesthesiology Faculty Papers

BACKGROUND: Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis.

METHODS: This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar …