Medicine and Health Sciences Commons^™

Heterocyclic Amines And Arylamine N-Acetyltransferase 2 Polymorphism In Pathogenesis Of Insulin Resistance., Kennedy M. Walls

Electronic Theses and Dissertations

Heterocyclic amines (HCAs) are formed when cooking meats at high temperatures or for long periods of time, and their major metabolic pathway includes hepatic N‑hydroxylation by CYP1A2 followed by O-acetylation by N-acetyltransferase 2 (NAT2). NAT2 is a highly polymorphic gene involved in metabolism of drugs and xenobiotics, and its single nucleotide polymorphisms (SNPs) produce phenotypes characterized as slow, intermediate, or rapid acetylator. Recent studies have documented associations between HCAs and insulin resistance and between certain NAT2 phenotypes and insulin resistance. In this study, we demonstrated that NAT2 activity and exposure to certain HCAs may alter cellular glucose …

Particulate Matter Exposure And Community-Acquired Pneumonia Mortality Among Hospitalized Adults With Pneumococcal Pneumonia: Incidence Study (Happi) Participants., Jack Anthony Pfeiffer

Electronic Theses and Dissertations

The role of air pollution as an agent of elevated morbidity and mortality has come under increasingly intense scrutiny in recent years. As the body of literature grows, so too does our understanding of how extensive the harm of such pollutants can be. Particulate matter (PM) particularly harmful due to its small size, ability to travel great distance while airborne, and capacity to infiltrate numerous bodily systems, often to the detriment of those exposed. Besides being associated with increased mortality risk in more heavily exposed populations, PM exposure has also been associated with complications in the respiratory, cardiovascular, and nervous …

Anxiety And Self-Efficacy Related To Learning Neuroanatomy In An Integrated Medical Curriculum., Jessica S. Bergden

Electronic Theses and Dissertations

Medical student anxiety towards learning neuroanatomy — neurophobia, a key obstacle in medical education, is influencing medical student success and potentially swaying medical students away from neurology careers. This is particularly concerning with condensed neuroanatomy instructional hours from curriculum integration and the concurrent shortage of neurologists, combined with the rising prevalence of neurological disease, and medical students choosing neurological specialties at lower rates. Neuroanatomy education is one factor described in the literature as contributing toneurophobia, yet specific ways in which neuroanatomy education could be improved have not yet been explained. In this present work, we demonstrate four specific domains, namely …

Evaluation And Optimization Of Medication Related Fall Risk At A Community Hospital, Giselle Chahili, Thomas Wolfel, Heidi Clarke, Erika Dittmar

All Publications

Background: Falls occur commonly in older adults at a rate of 3-5 per 1000 beds in healthcare settings. They can results in increased length of stay, morbidity and mortality, and healthcare costs. Some risk factors include older age, environmental hazards and medications. Currently at BHM, patient’s risk for falling is assessed based on Morse Fall Scale (MFS), which does include drugs as part of its assessment. The purpose of this project is to integrate medication risk evaluation into our current fall assessment.

Methodology: single-centered, retrospective, IRB-reviewed quality improvement project at BHM. We included patients over age 18 who fell with …

Pharmacists’ Role In The Management Of Patients Receiving Dual Or Triple Antithrombotic Therapy, Laura Neubauer, Radhan Gopalani, Kristen De Almeida

All Publications

Purpose: Patients on dual and triple antithrombotic therapy present the therapeutic dilemma of mitigating bleed risk while sustaining antithrombotic efficacy. Lack of literature and variability in existing published guidance potentiates inconsistent management of these patients. Furthermore, suboptimal dosing of direct oral anticoagulants is relatively common. One study reported as high as 43% of patients receive higher and 13% receive lower than clinically indicated doses. These findings were associated with a significantly increased risk of major bleeding and incidence of stroke, thus highlighting the importance of selecting an ideal regimen. The purpose of this project is to highlight pharmacists’ role in …

Evaluation Of An Elevated Vte Thromboprophylaxis Guideline For Critically Ill Patients Infected With Covid-19, Tony Nguyen, Heidi Clarke

All Publications

Retrospective studies and systematic-review meta-analysis have shown an association in inducing a prothrombotic state in patients infected with COVID-19. The risk of VTE are compounded in the critically ill. Current practices at Baptist Hospital of Miami (BHM) is to routinely order standard prophylactic dosed chemical thromboprophylaxis for all patients infected with COVID-19. In August 2020 an anticoagulation guidance document was approved to tailor anticoagulation dosing for critically ill COVID-19 patients. At risk patients were based on clinical and laboratory markers such as D-dimer, CRP, and ferritin. Following implementation, our analysis show a statistically significant reduction in the number of treatment …

A New All-Natural Wound Treatment Gel Shows Strong Inhibitory Activity Against Staphylococcus Aureus And Other Wound Pathogens, Tasha K. Nelson

Electronic Theses and Dissertations

Skin related injuries are some of the most dangerous forms of wounds. In addition to treating the wound itself, health care providers must be cautious of microbial infections. In this study, we evaluate a novel all-natural antimicrobial gel compound (AMG) designed to kill planktonic bacteria, penetrate bacterial biofilms, and accelerate wound healing. In -vitro experiments demonstrate that AMG is effective in inhibiting planktonic growth and biofilm development of eight common pathogens. LIVE/DEAD staining and confocal microscopy reveal that planktonic growth and three-dimensional structure of biofilms were significantly reduced. Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) was used to investigate a small …

Identification Of Transcription Regulators Of The Algz/R Two-Components Regulatory System In Pseudomonas Aeruginosa, Kwasi Yeboah

Electronic Theses and Dissertations

Pseudomonas aeruginosa is an opportunistic pathogen that express a plethora of virulence components controlled through two-component regulatory systems that allow for sensing and responding to environmental stimuli. This study was aimed at identifying transcription regulators of algZ that encodes the histidine sensor kinase (AlgZ) of the AlgZR two-component regulatory system. To understand how the algZ gene is transcriptionally controlled, transposon mutagenesis was used to create a mutant library with varying algZ expression based on their b-Galactosidase activity. The gene PA3327 was identified as a potential regulator of algZ expression using arbitrary PCR. This gene encodes a probable non-ribosomal peptide synthetase …

How Nutrition Knowledge Of Coaches, Athletic Trainers, And Strength And Conditioning Specialists Translates To Their Athletes, Alexa Carbone

Electronic Theses and Dissertations

The basis of dietary habits is linked to an individuals’ nutrition knowledge; for collegiate athletes this is the difference between optimal performance and falling short. To understand how nutrition information is disseminated to student-athletes, this research surveyed the athletes themselves and their sports staff (coaches, athletic trainers, and strength and conditioning specialists) on their current knowledge. Sport staff and student-athletes at East Tennessee State University were given the opportunity to participate in a 52-question online survey that tested both their general and sports-related nutrition knowledge. While the study sample size did not allow for statistical analyses required to address all …

Vitamin B12 Deficiency Does Not Stimulate Amyloid-Beta Toxicity In A Ceanorhabditis Elegans Model Of Alzheimer’S Disease, Opeyemi F. Showemimo

Electronic Theses and Dissertations

Alzheimer’s disease (AD) is symptomized by amyloid-beta plaques in the brain and accounts for more than 65 percent of dementia cases. Vitamin B12 (cobalamin) deficiency can result in similar cognitive impairment and roughly 15% of the elderly are vitamin B12 deficient. Vitamin B12 deficiency results in the accumulation of toxic methylmalonic acid and homocysteine. Hyperhomocysteinemia is a strong risk factor for AD. To test if vitamin B12 deficiency stimulates amyloid-beta toxicity, Caenorhabditis elegans expressing amyloid-beta in muscle were fed either vitamin B12-deficient OP50-1 or vitamin B12-rich HT115(DE3) E. coli bacteria. Increased amyloid-beta toxicity was found in worms fed the …

Sarcopenia Screening By Registered Dietitian Nutritionists (Rdns) In The United States (U.S.), Madison Marcom

Electronic Theses and Dissertations

Sarcopenia is a disease of muscle wasting primarily seen in older adults. Although this term was first coined over three decades ago, there is a lack of consensus on a definition, screening criteria, and treatment protocol for sarcopenia. The primary purpose of this study is to determine whether registered dietitian nutritionists (RDNs) in the United States (U.S.) screen for sarcopenia. Study participants were recruited through a randomized email list and included RDNs throughout the U.S. Respondents completed a survey questioning knowledge of sarcopenia, screening tools and company protocols in place, and the need and desire for sarcopenia education. Data revealed …

Hemin Utilization In Rhizobium Leguminosarum Atcc 14479, John Lusby

Electronic Theses and Dissertations

Rhizobium leguminosarum is a Gram negative, motile, nitrogen-fixing soil bacterium. Due to the scarcity of iron in the soil bacteria have developed a wide range of iron scavenging systems. The two types of iron scavenging systems used are indirect and direct. In-silico analysis of the genome identified a unique direct iron scavenging system the Hmu operon. This system has been identified in other closely related rhizobium species and is believed to be involved in utilizing heme compounds as a sole source of iron. We have attempted to characterize the role of the Hmu operon in iron utilization by monitoring the …

Can The Conventional Cytology Technique Be Sufficient In A Center Lacking Rose?: Retrospective Study During The Covid-19 Pandemic, Mohamed Hammad, Nader Alwifati, Mohamed Ajala, Nour Keshlaf, Dalia M.Khair, Marwan Alsari, Yousef M. Hasen, Ali Tumi, Mohamed Sultan

Marshall Journal of Medicine

Introduction

While rapid on-site evaluation (ROSE) is considered to be an additional tool to optimize the yield of tissue acquisition during EUS-guided FNA of the gastrointestinal tract,^1,2 it is not readily available at all times while performing these procedures.

Methods

We reviewed twenty-seven EUS-guided FNA procedures done at our institution in Tripoli central hospital with general working center restrictions due to local COVID-19 prevention protocols. This is a small-size retrospective chart review study to illustrate the optimal tissue adequacy during EUS-guided FNA of the upper gastrointestinal tract in a suboptimal hospital setting, lack of ROSE and merely utilizing visual …

Impact Of A Faculty Development Course On Promotion At A Health Sciences Center, Sanja Kupesic Plavsic, Valerie Osland Paton Ph.D., Christiane Herber-Valdez, Consuelo Rosales, Martín D. García, Zuber D. Mulla

Marshall Journal of Medicine

Introduction

The objective of this study was to quantify the association between graduation from our annual comprehensive Institutional Faculty Development Course (IFDC) and being promoted from assistant professor to associate professor at our health sciences center.

Methods

A retrospective cohort study (October 2008-October 2019) was conducted using publicly-available faculty data. A total of 148 IFDC graduates were compared to 87 non-graduates. Subjects were full-time assistant professors at Texas Tech University Health Sciences Center El Paso at the start of follow-up. The binary outcome was promotion to associate professor. The outcome was measured annually from 2008 to 2019. Follow-up ended when …

Non-Selective Primary Human Tumor Cell Line Generation From Surgical Resections To Be Paired With Flash Frozen And Paraffin Embedded Tissue: Advancements In Democratizing Translational Research Materials To Rural Institutions, Jennifer Hawkins, Rebecca Russell, Logan M. Lawrence, Amrita Valluri, Jessica Wellman, Krista Denning

Marshall Journal of Medicine

Translational cancer research relies on the availability of human patient tissue demonstrating the specific disease process under investigation. Biobanks of human tissue have historically been and remain to date the primary access point for cancer research samples. Biorepositories routinely supply researchers with varying sample types for use in biomedical studies; most commonly formalin-fixed and paraffin-embedded (FFPE) tissue, or fresh snap-frozen tissue. In conjunction with preserved tissue samples, viable tumor cell lines derived from patient tissue have emerged to be a new gold standard in cancer research particularly in drug discovery and functional prognostic assays. Tissue banks providing these samples are …

Mr. Watson, Come Here-I Want To See You: One Rural Residency Program’S Rapid Pivot To Telemedicine During The Pandemic, William J. Crump, Diana M. Nims, Douglas J. Hatler

Marshall Journal of Medicine

Introduction

Telemedicine has been used for over a generation, but application has been limited in rural areas due to lack of payment, licensure issues, cumbersome video equipment, and challenges with digital communications. Early in the COVID-19 pandemic, our rural family medicine residency made a rapid shift to all telemedicine services for our patients.

Methods

We collected data over a four-week period in April 2020 as we transitioned to 100% telemedicine consultations. We compare that to a four-week period prior to mid-March when COVID-related shutdowns began. We collected detailed visit summaries, patient feedback, and physician feedback to compare these two periods. …

Comparison Of Direct Staffing Costs Of Advanced Practice Providers And Residents In A High Acuity Area Of A Community Emergency Department, Kyle B. Smith, Christopher Kiefer, Erica Shaver, Kimberly D. Quedado, Thomas Marshall, Jerome Kerwin, Christopher Goode

Marshall Journal of Medicine

Introduction

Resident physicians and advanced practice providers (APPs) both have roles in providing care within emergency departments (ED). While both bring unique skill sets and capabilities to the health care team, little is known about the comparative financial impact of APPs and residents in a community ED. The objective of this study was to compare direct staffing costs per relative value unit (RVU) generated of emergency medicine (EM) residents and APPs in a community ED setting.

Methods

This was a retrospective, observational analysis of RVU productivity of resident physicians and APPs in the high acuity area of a community ED. …

Arthritis Post-Immunotherapy For Endometrial Cancer: A Case Report And Review Of Literature On The Acute Onset Of Inflammatory Arthritis Following Pd-I Inhibitor Therapy In A Patient With Recurrent Endometrial Cancer, Sydney Graham, Emily Sloane, Nadim Bou Zgheib

Marshall Journal of Medicine

Since gaining FDA approval in 2014, pembrolizumab, a PD-1 immune checkpoint inhibitor, has been utilized in the management of cancers that progress following first-line therapy.While the pathological response to pembrolizumab is favorable, immune related adverse events (irAEs) can be elicited and require prompt diagnosis and management based on grading and severity, which can include discontinuation of immunotherapy.Our case concerns a 66-year-old female with recurrent endometrial cancer who was treated with pembrolizumab, and developed inflammatory arthritis following therapy. We provide a succinct review of the pathogenesis and risk factors associated with irAEs, as well as diagnosis and management strategies.

Recurrent Spontaneous Pneumothorax During Pregnancy; A Case Report, Andrew J. Weaver, Wai Hau, Mark H. Cooper

Marshall Journal of Medicine

Spontaneous pneumothorax is a rare but potentially life-threatening condition during pregnancy. We discuss a case of recurrent spontaneous pneumothorax during a single pregnancy. The pneumothorax occurred twice during the pregnancy, first in the second trimester and again in the third trimester with both times being managed conservatively. Due to the low prevalence of this condition management guidelines are few. We report our management of recurrent spontaneous pneumothorax during pregnancy to support the literature and current guidelines.

Acquired Aorto-Atrial Fistula From Intravenous Drug Use With Underlying Congenital Heart Disease., Mohamed Tashani, Laura Given, Emhemmid Karem, Mahmoud Abualayem

Marshall Journal of Medicine

The development of an aorta-atrial fistula secondary to mechanical aortic valve infective endocarditis, is a rare, serious complication. The fistula is an aberrant intra-cardiac shunt that occurs between the aorta and either the left or right atrium.

An aorta-atrial fistula can be congenital or acquired. In the case of infective endocarditis, the infection’s expansion beyond the valvular structure, may result in an aorto-cavitary fistula (ACF or AAF) with an estimated incidence of 1-2% (1). No clinical trials have been conducted for the best approach of management for this condition. Therefore, treatment strategies are applied to a case-by-case basis by expert …

Boots On The Ground And Shots In Arms: A West Virginia Pharmacist On Covid-19 Vaccinations., Charles Massey

Marshall Journal of Medicine

No abstract provided.

Leveraging A Public-Private-Academic Collaborative Partnership To Confront Challenges In The Covid-19 Pandemic., James Denvir

Marshall Journal of Medicine

Like all viruses, the SARS-CoV-2 virus mutates over time, creating new viral variants that have the potential to transmit more rapidly, cause more severe disease, or avoid treatment and prevention strategies. A critical component of the public health response to COVID-19 is identifying and tracking emergence of SARS-CoV-2 variants. In West Virginia, this effort is coordinated via a public-private-academic collaboration.

It Takes A Village: A Collaborative Approach To The Covid-19 Pandemic, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

A Moment Of Peace: An Artistic Representation Of The Influence Of Healthcare On Social Disruption, Nafisa Choudhury

HCA Healthcare Journal of Medicine

This original pen-and-ink artwork features a lily on the water symbolizing peace. As war, distrust, chaos and coups wreak havoc throughout many developing nations, healthcare workers and public health officials should be encouraged that we do in fact have a part to play in managing the human health affected by the disruption. Health work can provide a zone of comfort, spread solidarity and understanding, and manage the human toll of war. Healthcare workers have major roles in peace-keeping efforts as a result of these determinations and their impact on peace should be acknowledged and lauded. We hope that as we …

After Code Blue, Komal Kinger

HCA Healthcare Journal of Medicine

Starting intern year comes with its own challenges and learning opportunities, especially in a pandemic. In this paper I reflect on one such situation. The code and passing of a particular patient earlier this year taught me many lessons and it has impacted the type of physician I aspire to be.

Localization Of Hand And Wrist Anatomic Structures Among Physical Medicine And Rehabilitation Residents: Implication Of Ultrasonography In Palpation Skill Verification, Se Won Lee, Phuong Uyen Le, Craig Van Dien, Stefanie Lai, Eric Aguila

HCA Healthcare Journal of Medicine

Objective

The objective of this cross-sectional study is to evaluate the accuracy of physical medicine and rehabilitation (PM&R) resident palpation skills of hand and wrist joint and soft tissue structures using ultrasonography (US) verification.

Methods

PM&R residents palpated hand and wrist anatomic structures in an outpatient musculoskeletal (MSK) clinic. Once the presumed structures were localized, residents marked a one centimeter size circle on the overlying skin with an ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US.

Results

Overall palpation accuracy for 16 joint line and soft tissue structures was …

Hyperglycemia Followed By An Abrupt Decrease Of Blood Glucose Is A Rare Cause Of Posterior Reversible Encephalopathy Syndrome (Pres), Liza Garabet Diramerian, Nabila Ashraf, Admir Syla, Armen Malkhasian, Jason Madey

HCA Healthcare Journal of Medicine

Introduction

Posterior Reversible Encephalopathic Syndrome (PRES) is a clinical syndrome of headache, confusion or decreased level of consciousness, visual changes, seizures and focal neurologic signs associated with characteristic neuroimaging findings of posterior cerebral white matter edema. In most cases, PRES is precipitated by sudden increase in blood pressure; however, in the case presented here, the etiology was different as it was secondary to extreme changes in glucose levels.

Case Presentation

A 49-year-old female with a past medical history of hypertension and diabetes mellitus, type 2 was brought to the emergency room with a chief complaint of visual changes for 1 …

Hydrogen Peroxide Colitis: The Accidental Enema, Ramin Karimi, Ashish Sharma, Kevin Tran, Sebastian Montgomery

HCA Healthcare Journal of Medicine

Chemical colitis is defined as inflammation of the large intestine or colon as a result of exposure from a harsh chemical through an enema or other procedure. In this case, the chemical is hydrogen peroxide, which is commonly used as an antiseptic for minor abrasions. Hydrogen peroxide enemas were once popular for difficult to treat constipation. However, resultant colitis and proctitis limited its use. When administered rectally in a high enough concentration, intense abdominal pain and transient bloody diarrhea can occur, with the majority of affected patients making a full recovery with supportive management. Here we discuss a case of …

Tuberculoid Leprosy Masquerading As Erythema Induratum, Manuel Britto, Danish M. Siddiq, Michael Morgan, Anthony Dedea, Utpal Patel

HCA Healthcare Journal of Medicine

Introduction

Erythema Induratum (EI) is a relatively rare dermatologic disorder affecting subcutaneous fat tissue, which is often associated with Mycobacterium tuberculosis. This report details the presentation, diagnosis and management in a 70-year-old female who presented with a painful erythematous annular rash at the clinic. The rash was later diagnosed as EI associated with Mycobacterium leprae, one rarely seen in literature.

Discussion

EI is a rare form of panniculitis that typically presents as a recurrent grouping of tender nodules and plaques on the posterior aspect of the lower legs. Although EI is considered idiopathic in most cases, it can be associated …

Erythema Ab Igne: Toasted Skin Syndrome, Vincent Ly, James E. Vandruff, Julia Fashner

HCA Healthcare Journal of Medicine

Introduction

Erythema ab igne is a benign skin condition caused by long-term exposure to infrared radiation and/or heat. Erythema ab igne begins as a mild erythema over the previously exposed areas and develops into an erythematous reticulated hyperpigmentation with scaling and telangiectasias.

Clinical Findings

A 55-year-old female presented to the primary care clinic with concerns due to the development of a rash on her lower back in the previous 1 to 2 weeks. She had a history of chronic back pain and was using conservative treatment for pain management, including daily use of a heating pad for 15 minutes every …