Medicine and Health Sciences Commons^™

Catastrophic Perforation In Streptococcus Pneumoniae Aortitis: Complications Of Infective Endocarditis In The Current Antimicrobial Era, Sana Shaikh, Jorge Isaac Peña Garcia, Michelle Shieh, Alexandre Lacasse

Journal of Community Hospital Internal Medicine Perspectives

Infectious aortitis is an uncommon but life-threatening cause of aortitis. Given the lack of specific symptoms, establishing the diagnosis is often a challenge. When it is associated with an endovascular infection, such as infective endocarditis, blood cultures may be diagnostic although often limited by low positive predictive value. Imaging studies may reveal characteristic findings, with computerized tomography angiography being the most sensitive. Management includes prompt initiation of antimicrobial therapy followed by surgical intervention, keeping in mind that operative mortality is high due to weakened arterial wall integrity. Here we describe a 25-year-old woman without relevant medical history, who presented to …

Intravascular Large B Cell Lymphoma - Still A Diagnostic Dilemma, Abuzar A. Asif, Manisha Tharoor, Jacqueline L. Fischer

Journal of Community Hospital Internal Medicine Perspectives

Intravascular large B cell lymphoma (IVLBCL), a rare subtype of diffuse large B cell lymphoma (DLBCL), presents with non- specific symptoms and is an extremely difficult diagnosis to make despite extensive workup. It very rarely presents with endocrinological abnormalities. We present a case of an 81-year-old woman whose predominant presenting manifestation was endocrinopathy, who passed away from multiorgan failure, and was diagnosed to have IVLBCL on post mortem autopsy.

Pyloric Stenosis: A Rare Manifestation Of Crohn’S Disease, Rajarajeshwari Ramachandran, Eric Then, Tyler Grantham, Swetha Parvataneni, Vinaya Gaduputi

Journal of Community Hospital Internal Medicine Perspectives

We are presenting a rare case of pyloric stenosis due to Crohn’s disease. A 53-year-old woman with prior history of colonic Crohn’s disease was admitted to the hospital with gastric outlet obstruction. Esophagogastroduodenoscopy demonstrated pyloric stenosis and biopsy was consistent with Crohn’s disease. She was treated with corticosteroids and her condition improved.

Atypical Lemierre’S Syndrome. A Case Report And Review Of Literature, Anum Qureshi, Theodore Bailey, Michael Atkinson, Khadija Tayabali

Journal of Community Hospital Internal Medicine Perspectives

Lemierre’s syndrome (LS) is a rare disease entity, which can be catastrophic if organism-directed treatment is not initiated early. Lemierre’s syndrome is frequently caused by Fusobacterium infection which is frequently susceptible to clindamycin. Evidence suggests there is an increase in the incidence of cases of drug resistant Fusobacterium species. Through this case we wish to present a unique case of a 45- year-old Caucasian female with Lemierre’s Syndrome due to Clindamycin Resistant Fusobacterium that developed recurrent infections despite being on antibiotics.

A Case Of Internet Gaming Disorder: When #Playaparttogether Takes A Dark Turn, Jessica O'Loughlin, Emily Pelletier, Elizabeth Loomis, Richard Alweis

Journal of Community Hospital Internal Medicine Perspectives

Background:
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) places internet Gaming disorder (IGD) in its research appendix as a potential new behavioral addiction diagnosis that requires further investigation. As part of the media campaign #HealthyAtHome, recommendation to relieve stress and anxiety during COVID-19, the World Health Organization (WHO) advocated for the playing of video games. The encouragement and expansion of playing video games may have led to the unintentional consequence of increasing the prevalence of IGD as IGD has been postulated to be a maladaptive response to stress.

Case:
A 34 year old male presented to his primary …

Implementing Perioperative Cardiac Risk Assessment In An Internal Medicine Residency Program: Experience From A Community Hospital, Ji Hyun Yang, Klaorat Prasongdee, Ivy Riano, Elman Urbina, Alekya Poloju, Thomas Treadwell, Eric Chun

Journal of Community Hospital Internal Medicine Perspectives

Background
ACGME requires all Internal Medicine training programs to structure the curriculum to optimize resident educational experiences, including perioperative medicine. Teaching residents about perioperative risk management is challenging in a community hospital with limited resources and low surgical volume.

Objective
Our goal was to introduce an interactive educational module on perioperative cardiac risk assessment and management in a community residency training program.

Methods
The study was a single-center online education-based intervention from September 2020 to January 2021. 24 categorical internal medicine residents at MetroWest Medical center were included. A self-paced online education program followed by two sessions of a 30- …

A Retrospective Analysis Of Respiratory Complications Under General Anesthesia During Ebus-Tbna, Emily A. S. Bergbower, Caron Hong, Miranda Gibbons, Ashutosh Sachdeva, Peter Rock, Megan G. Anders

Journal of Community Hospital Internal Medicine Perspectives

Background: EBUS-TBNA is an established technique for diagnostically sampling intrathoracic masses and lymph nodes. While the procedure is commonly conducted under general anesthesia (GA), little is known regarding the association between anesthetic management and perioperative respiratory complications. Here, we aim to evaluate this association among patients presenting for EBUS-TBNA. Methods: 586 patients receiving GA for EBUS-TBNA between 2012 and 2018 were retrospectively evaluated. The primary endpoint was the occurrence of perioperative respiratory complications and the secondary endpoint was procedure end to OR exit time (minutes). Respiratory complications were defined as episodes of severe (SpO2 5 minutes) hypoxemia, bronchospasm, and postoperative …

A Dangerous Duo: Spontaneous Pneumomediastinum And Venous Thromboembolism At Presentation In A Patient With Covid-19 Pneumonia, Sabina Nasirova, Nargiz Muganlinskaya, Orighomisan Pessu, Arshdeep Brar

Journal of Community Hospital Internal Medicine Perspectives

Background
Coronavirus disease 2019 (Covid-19) is associated with spontaneous pneumomediastinum (SPM) predominantly in those after positive pressure ventilation (PPV) support. Additionally, many cases of venous thromboembolism (VTE) in COVID- 19 patients were described. Our case is the first to describe SPM and VTE present on admission in a patient with Covid -19 pneumonia.

Case report
A 53-year-old man presented to the hospital with escalating dyspnea. Two weeks prior to this visit, he had been evaluated in an ambulatory setting and was started on antibiotics and systemic steroids. In the hospital, this patient was found to be in acute hypoxic respiratory …

Exploring Data And Literature Currently Available On The Covid-19 Vaccines, Pooja Gogia, Hamza Ashraf, Sidharth Bhasin, Douglas Frenia

Journal of Community Hospital Internal Medicine Perspectives

The COVID-19 pandemic has been labeled one of the most lethal pandemics in human history. As a result, there has been a high level of urgency throughout the world to establish successful vaccinations to subdue the effects of the virus and return to a level of normalcy. This study aims to investigate the different COVID-19 vaccines available both in the United States and across the globe. Through exploration of how the vaccines were developed, how they elicit immunity, their efficacy, and their safety profiles, this study has the goal of increasing the amount of knowledge regarding the vaccines available to …

Conversations With Individuals On The Fence About Cv-19 Vaccination: Analysis Of Lives Saved By Vaccine Vs. Natural Infection Mortality And Other Reflections, Jacob Sokol, Greg Haggerty, Alexander Driver-Benjamin, Alan Kaell

Journal of Community Hospital Internal Medicine Perspectives

As of June 15, 2021, from 672,000 to 912,000 deaths have been averted through vaccination of 48% of the US population. Because 52% remain unvaccinated, 728,000 to 988,000 lives remain at risk. These deaths can be spared, and the pandemic stopped in its tracks provided a final national vaccination rate of 84% is achieved. We aim to demonstrate in our analysis of the number of lives saved that can be attributed to CV-19 vaccination vs the mortality rate of natural infection seen in unvaccinated individuals. However, time is short given the recent exponential rise of the highly contagious SARS-CoV-2 Delta …

Seizure Prediction In Epilepsy Patients, Gary Dean Cravens

NSU REACH and IPE Day

Purpose/Objective: Characterize rigorously the preictal period in epilepsy patients to improve the development of seizure prediction techniques. Background/Rationale: 30% of epilepsy patients are not well-controlled on medications and would benefit immensely from reliable seizure prediction. Methods/Methodology: Computational model consisting of in-silico Hodgkin-Huxley neurons arranged in a small-world topology using the Watts-Strogatz algorithm is used to generate synthetic electrocorticographic (ECoG) signals. ECoG data from 18 epilepsy patients is used to validate the model. Unsupervised machine learning is used with both patient and synthetic data to identify potential electrophysiologic biomarkers of the preictal period. Results/Findings: The model has shown states corresponding to …

Evanescent - Issue 3

Evanescent

Evanescent: A Journal of Literary Medicine is the journal of the Eakins Writers’ Workshop, which also sponsors the Drs. Theresa and Charles Yeo Writing Prize. The Eakins Writers’ Workshop is supported by the Jefferson Center for Injury Research and Prevention.

Contents:

• Letters From The Editors
• Struggle/Growth
• The Drs. Theresa and Charles Yeo Writing Prize: First Place
• Stasis/Change
• The Drs. Theresa and Charles Yeo Writing Prize: Second Place
• Vulnerability/Strength
• The Drs. Theresa and Charles Yeo Writing Prize: Third Place
• Wonder/Wisdom
• Gratitude/Insight
• Afterword
• List of Contributors

A Systematic Review To Propose An Evidence-Based Nutrition Protocol In Depression, Camilla A. Mirkin, Nicole Koci

NSU REACH and IPE Day

Background: Rates of depression have been rising steadily over the last several decades with more than 264 million people affected, making it one of the top three burdens globally. The pandemic has brought on a greater risk of depression. Forty-two percent of individuals surveyed in December 2020 by the US Census Bureau reported depressive symptoms. Many factors, including poor diet quality, play a role in the development of depression during traumatic events like the pandemic. A low-quality dietary pattern has been associated with obesity, low-grade chronic inflammation, dysbiosis, increased cortisol levels and monoamine neurotransmitter deficiency. Among others, these factors have …

The Role Of Healthcare Workers In The Care Of Human Trafficking Survivors, Darisel N. Ventura Rodriguez

NSU REACH and IPE Day

Purpose/Objective: Highlight the importance of increasing awareness among healthcare professionals on the identification and treatment of human trafficking victims. Background/Rationale: In the state of Florida, human trafficking (HT) remains a significant public health issue affecting hundreds of victims each year. Miami-Dade and Broward Counties reported 351 cases in 2019 alone. More than 50% of HT victims encounter healthcare providers while being exploited. For this reason, healthcare providers must be trained to recognize and treat victims of HT. The goal of this project was to educate healthcare providers and students on the identification of HT victims and how to provide trauma-informed …

Using Complex Medical Devices: Icu Nurses' Safety Perceptions, Violet Rhagnanan-Kramer

NSU REACH and IPE Day

Purpose: The purpose of this study was to gain insight into ICU nurses’ safety perceptions and explore continuing educational strategies for improving nurses’ technological competence. Background: Medical errors are the third leading cause of death in America. Over 10,000 medical errors occur daily, with an estimated financial impact of preventable mistakes is 20 billion dollars annually. Increasing the use of multifarious sophisticated medical technologies in the Intensive Care Unit (ICU) poses a risk of medical errors and unintentional harm to patients. However, limited empirical evidence exists regarding ICU nurses’ perspectives. Methods: This research featured an online mixed methods descriptive exploratory …

Medical School Watercooler Newsletter - February 17, 2022, Lindsey Lyle

Watercooler Newsletter

This is the February 17, 2022 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents include:

• Faculty Spotlight: Wei Xin, M.D., Ph.D.
• Medical student wins National Fellowship award
• USA Health featured in new TLC series ‘Stuck’
• Wanted: Faculty members interested in academic coaching

2022-02-17_Michiganoverview_Misc, Michigan Department Of Health & Human Services

Michigan COVID-19 MIS-C Data

The MIS-C Data page was obtained from Michigan's COVID-19 data page: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173_104661---,00.html.

This report is created by the Michigan Department of Health & Human Services from data self-reported by health care providers and local health departments. Data is updated on the first and third Thursdays of the month.

Multisystem Inflammatory Syndrome in Children (MIS-C) is a condition in children and adolescents under 21 years of age where multiple organ systems become inflamed or dysfunctional which occurs in association with illness. Children with MIS-C may have a fever and various symptoms, including abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, …

A Splicing Mutation In Slc4a5 Results In Retinal Detachment And Retinal Pigment Epithelium Dysfunction, Gayle B. Collin, Lanying Shi, Minzhong Yu, Nurten Akturk, Jeremy R. Charette, Lillian F Hyde, Sonia M Weatherly, Martin Pera, Juergen K. Naggert, Neal S Peachey, Patsy M. Nishina, Mark P. Krebs

Faculty Research 2022

Fluid and solute transporters of the retinal pigment epithelium (RPE) are core components of the outer blood-retinal barrier. Characterizing these transporters and their role in retinal homeostasis may provide insights into ocular function and disease. Here, we describe RPE defects in tvrm77 mice, which exhibit hypopigmented patches in the central retina. Mapping and nucleotide sequencing of tvrm77 mice revealed a disrupted 5' splice donor sequence in Slc4a5, a sodium bicarbonate cotransporter gene. Slc4a5 expression was reduced 19.7-fold in tvrm77 RPE relative to controls, and alternative splice variants were detected. SLC4A5 was localized to the Golgi apparatus of cultured human …

Spatiotemporal Dynamics Of Clonal Selection And Diversification In Normal Endometrial Epithelium., Manako Yamaguchi, Hirofumi Nakaoka, Kazuaki Suda, Kosuke Yoshihara, Tatsuya Ishiguro, Nozomi Yachida, Kyota Saito, Haruka Ueda, Kentaro Sugino, Yutaro Mori, Kaoru Yamawaki, Ryo Tamura, Sundaramoorthy Revathidevi, Teiichi Motoyama, Kazuki Tainaka, Roel G W Verhaak, Ituro Inoue, Takayuki Enomoto

Faculty Research 2022

It has become evident that somatic mutations in cancer-associated genes accumulate in the normal endometrium, but spatiotemporal understanding of the evolution and expansion of mutant clones is limited. To elucidate the timing and mechanism of the clonal expansion of somatic mutations in cancer-associated genes in the normal endometrium, we sequence 1311 endometrial glands from 37 women. By collecting endometrial glands from different parts of the endometrium, we show that multiple glands with the same somatic mutations occupy substantial areas of the endometrium. We demonstrate that "rhizome structures", in which the basal glands run horizontally along the muscular layer and multiple …

Murine Model For Measuring Effects Of Humanized-Dosing Of Antibiotics On The Gut Microbiome., Shana Leopold, Kamilia Abdelraouf, David P Nicolau, Hanako Agresta, Jethro Johnson, Kathleen Teter, Wm Michael Dunne, David Broadwell, Alex Van Belkum, Lisa M Schechter, Erica J Sodergren, George M. Weinstock

Faculty Research 2022

There is a current need for enhancing our insight in the effects of antimicrobial treatment on the composition of human microbiota. Also, the spontaneous restoration of the microbiota after antimicrobial treatment requires better understanding. This is best addressed in well-defined animal models. We here present a model in which immune-competent or neutropenic mice were administered piperacillin-tazobactam (TZP) according to human treatment schedules. Before, during and after the TZP treatment, fecal specimens were longitudinally collected at established intervals over several weeks. Gut microbial taxonomic distribution and abundance were assessed through culture and molecular means during all periods. Non-targeted metabolomics analyses of …

Forward Together Update [Idph Updates Format Of Covid-19 Reporting & Encourages Vaccination], February 17, 2022, University Of Northern Iowa

UNI Response to COVID-19

Reports that the Iowa Department of Public Health has updated the format of their COVID-19 reporting data. Also a reminder that the Student Health Clinic has weekly times for COVID vaccinations throughout the 2022 spring semester.

Robert Brandt Interview For The Boonshoft School Of Medicine 50th Anniversary Oral History Project, Robert Brandt, Kristen Dilger

Boonshoft 50th Anniversary Oral History Project

Kristen Dilger interviews Robert Brandt, a graduate of the Boonshoft School of Medicine. He worked in Family Medicine as both a primary care physical and HIV/AIDS specialist, along with his role as a clinical professor for the Boonshoft School of Medicine until his retirement in 2018. Part of the class of 1980, Brandt discusses his collegiate career, including why he chose Wright State University's new medical college and talks about what it was like attending the college. He talks about the challenges and processes of attending a new medical college, and how attending the Wright State University Boonshoft School of …

Compliance With Guidelines For Treatment Of Staphylococcus Aureus Bacteremia Is Associated With Decreased Mortality In Patients Hospitalized For Community-Acquired Pneumonia With Staphylococcus Aureus Bacteremia, Leslie Beavin, Vidyulata Salunkhe, Shashvin Singh, Ahmed Gana, Balaji Sekaran, Mahder A. Tella, Stephen P. Furmanek, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Introduction: Staphylococcus aureus bacteremia has a minimum treatment duration of two weeks, while S. aureus community-acquired pneumonia (CAP) treatment is at least five days. Treatment failure, persistent bacteremia, and recurrence are common among patients with community-acquired S. aureus bacteremia. There is conflicting information in the current Infectious Diseases Society of America (IDSA) guidelines for the treatment of S.aureus bacteremia patients with CAP. Therefore, the appropriate treatment duration and modality for S. aureus CAP with bacteremia is unclear. The objective of this study was to compare outcomes among patients with S. aureus CAP and bacteremia treated in compliance versus non-compliance with …

Acute Left Atrial Compression After Ventricular Assist Device Placement, Max Rug Ruge, Tal Zivan, Ron Leong, Eric Feduska, Mahek Shah, J. Eduardo Rame, Howard Massey, René J Alvarez, Yevgeniy Brailvosky, Indranee Rajapreyar

Division of Internal Medicine Faculty Papers & Presentations

Highlights:

• Pump thrombosis commonly presents with hemolysis and device parameter fluctuations.
• Left atrial compression presents similarly to pump thrombosis but with no device fluctuations.
• Reference standard imaging test for ventricular device thrombus is contrast-enhanced CT.

Late-Stage Chemoenzymatic Installation Of Hydroxy-Bearing Allyl Moiety On The Indole Ring Of Tryptophan-Containing Peptides, Nagaraju Mupparapu, Lauren Brewster, Katrina F. Ostrom, Sherif I. Elshahawi

Pharmacy Faculty Articles and Research

The late-stage functionalization of indole- and tryptophan-containing compounds with reactive moieties facilitates downstream diversification and leads to changes in their biological properties. Here, the synthesis of two hydroxy-bearing allyl pyrophosphates is described. A chemoenzymatic method is demonstrated which uses a promiscuous indole prenyltransferase enzyme to install a dual reactive hydroxy-bearing allyl moiety directly on the indole ring of tryptophan-containing peptides. This is the first report of late-stage indole modifications with this reactive group.

Aapm Medical Physics Practice Guideline 12.A: Fluoroscopy Dose Management, Ryan F. Fisher, Kimberly E. Applegate, Lindsey K. Berkowitz, Olav Christianson, Jaydev K. Dave, Lindsay Deweese, Nichole Harris, Mary Ellen Jafari, A. Kyle Jones, Robert J. Kobistek, Brendan Loughran, Loren Marous, Donald L. Miller, Beth Schueler, Bryan C. Schwarz, Adam Springer, Kevin A. Wunderle

Radiology Faculty Publications

No abstract provided.

Patient-Centered Care: Disease Vs. Illness, Frantz Duffoo

CHED Talks

No abstract provided.

The Association Of Persistent Symptoms Of Depression And Anxiety With Recurrent Acute Coronary Syndrome Events: A Prospective Observational Study, Abdullah S. Alhurani, Ayman M. Hamdan-Mansour, Muayyad M. Ahmad, Gabrielle Mckee, Sharon O’Donnell, Frances O’Brien, Mary Mooney, Zyad T. Saleh, Debra K. Moser

Nursing Faculty Publications

The purpose of this study was to examine the role of persistent symptoms of depression and anxiety in a second acute coronary syndrome (ACS) event. Data presented in this study were from an RCT study. A follow-up for 24 months after baseline to detect a second ACS event among 1162 patients from five hospitals. Hierarchal Cox regression analyses were used. The results showed that persistent depression only (HR 2.27; 95% CI: 1.35–3.81; p = 0.002), and comorbid persistent depression and anxiety (HR 2.03; 95% CI: 1.03–3.98; p = 0.040) were the significant predictors of a second ACS event. Secondary education …

Sustained Efficacy And Safety Of Burosumab, A Monoclonal Antibody To Fgf23, In Children With X-Linked Hypophosphatemia, Agnès Linglart, Erik A Imel, Michael P Whyte, Anthony A Portale, Wolfgang Högler, Annemieke M Boot, Raja Padidela, William Van't Hoff, Gary S Gottesman, Angel Chen, Alison Skrinar, Mary Scott Roberts, Thomas O Carpenter

2020-Current year OA Pubs

PURPOSE: In X-linked hypophosphatemia (XLH), excess fibroblast growth factor-23 causes hypophosphatemia and low calcitriol, leading to musculoskeletal disease with clinical consequences. XLH treatment options include conventional oral phosphate with active vitamin D, or monotherapy with burosumab, a monoclonal antibody approved to treat children and adults with XLH. We have previously reported outcomes up to 64 weeks, and here we report safety and efficacy follow-up results up to 160 weeks from an open-label, multicenter, randomized, dose-finding trial of burosumab for 5- to 12-year-old children with XLH.

METHODS: After 1 week of conventional therapy washout, patients were randomized 1:1 to burosumab every …

Nanoscale Rules Governing The Organization Of Glutamate Receptors In Spine Synapses Are Subunit Specific, Martin Hruska, Rachel E Cain, Matthew B Dalva

Department of Neuroscience Faculty Papers

Heterotetrameric glutamate receptors are essential for the development, function, and plasticity of spine synapses but how they are organized to achieve this is not known. Here we show that the nanoscale organization of glutamate receptors containing specific subunits define distinct subsynaptic features. Glutamate receptors containing GluA2 or GluN1 subunits establish nanomodular elements precisely positioned relative to Synaptotagmin-1 positive presynaptic release sites that scale with spine size. Glutamate receptors containing GluA1 or GluN2B specify features that exhibit flexibility: GluA1-subunit containing AMPARs are found in larger spines, while GluN2B-subunit containing NMDARs are enriched in the smallest spines with neither following a strict …