Medicine and Health Sciences Commons^™

Rapid Recovery Of Peripheral Oxygen Saturation In Hypoxic Covid-19 Patients With Ivermectin/Doxycycline/Zinc Multidrug Therapy, Sabine Hazan, Adriana C. Vidal, Eleftherios Gkioulekas, Anoja W. Gunaratne, Sibaish Dolai, Robert L. Clancy, Peter A. Mccullough, Thomas J. Borody

School of Mathematical & Statistical Sciences Faculty Publications

Several combination therapies for the early outpatient treatment of COVID-19 were proposed by independent research groups at the onset of the pandemic during 2020 and 2021. In this observational study, we report on the outcomes of an off-label triple combination therapy, consisting of ivermectin, doxycycline, and zinc, with adjunct vitamin C and D3 supplementation, which was used on high-risk COVID-19 patients. These patients refused an initial recommendation to seek inpatient care, despite a high-risk presentation compounded with one or more comorbidities and/or severe hypoxia. Telemedicine was used to administer personalized treatment to patients at home, who did not have access …

Hypoglossal Nerve Stimulation For Obstructive Sleep Apnea: A Systematic Review And Meta-Analysis On Responder-Based Outcomes And Between-Study Heterogeneity, Clemens Heiser, Marcel Braun, Colin Huntley, Michael Hutz, Thomas Michael Kaffenberger, Maurits Boon

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background: Hypoglossal nerve stimulation (HNS) is an established surgical therapy for adults with moderate-to-severe obstructive sleep apnea (OSA) who are intolerant to positive airway pressure. Although aggregate response rates of ~70–80% have been reported, substantial variability across clinical settings remains poorly understood. Prior meta-analyses have largely emphasized pooled continuous outcomes, limiting interpretation of responder-based endpoints and drivers of between-study heterogeneity. Methods: A PRISMA-compliant systematic review and meta-analysis was performed. MEDLINE, Embase, and Cochrane CENTRAL were searched from inception through 31 December 2025. Eligible studies enrolled adults with OSA treated with implantable HNS, reported Sher-defined response (≥50% AHI reduction and residual …

Peer-Peer Mentoring In Undergraduate Medical Education (Ume): Scoping Review Of Us-Based Medical Schools, Sakshi Sehgal, Jordon Brinkley, Andrea Kadima, Sydney Wright, Nicole Winston Ms, Pharmd, Edd

Journal of the Georgia Public Health Association

Background: Mentorship plays a formative role in undergraduate medical education (UME) From shaping professional outcomes to developing longitudinal personal relationships, various forms of mentorship can influence student progress meaningfully, particularly for students from underrepresented or marginalized backgrounds. Though faculty-student mentorship has been readily investigated, limited knowledge exists regarding peer-peer mentorship structures, particularly within UME in the American medical education model. This scoping review sought to investigate existing peer-peer mentorship models, as well as report on the need for further mentorship within this realm in UME.

Methods: This scoping review employed Arksey and O’Malley’s framework. We conducted a systematic and comprehensive …

The Role Of Social Determinants Of Health In Hydroxyurea Adherence Among Persons With Sickle Cell Disease: A Systematic Review, Doreen O. Ugwu, Lori L. Vick, Terika Williams, Aurela Nikaj, Seyi Omeh, Benjamin Becerra Dr., Tilicia Mayo-Gamble

Journal of the Georgia Public Health Association

Objective: Georgia has one of the highest prevalences of sickle cell disease (SCD). For Georgians living with SCD, inadequate medication adherence is associated with important clinical outcomes. One important area that is understudied in SCD is the impact of social determinants of health (SDoH) on medication adherence. A foundational understanding of SDoH is needed to introduce, inform and carry out programs and interventions designed to facilitate hydroxyurea adherence through the state of Georgia.

Method: We conducted a systematic literature review to synthesize the literature on SDoH addressed in studies to improve hydroxyurea adherence in persons with SCD. SDoH were based …

Perspective On Lessons Not Learned: From Coley’S Toxins To Microbial Drug Delivery, Guidance For Institutional Review Boards (Irbs), Brian P. Hanley, Alejandro J. Betancourt, Gustavo Gross, Wilbur (Bo) Bowne

School of Medicine Publications

The bacterial and toxin methods of cancer treatment date back 130 years. This paradigm rests on nonspecific bacterial-toxin-generated immunotherapy. This high-risk oncology research is experiencing a renaissance of methods that are among the most effective yet. Glioblastomas and other resistant cancers are the modern touchpoint, because of remission history following sepsis. Spurred by recent research deaths, we discuss protocols IRBs should consider in live bacterial or synthetic immuno-stimulatory trials. Human systemic inflammatory response syndrome immunology is unique due to non-functioning SIGLEC-13 and 17, which control excessive Toll-like receptor 4 (TLR-4) signaling. This is not a technicality like human CD8+/CD4+ T …

Ai-Driven Detection Of Neurodevelopmental Disorder From Emotional Speech Using A Hybrid Cnn–Bilstm–Attention Framework, Nayarah Shabir, Parveen Lehana, Sheema Khan

School of Medicine Publications

Neurodevelopmental disorders (NDDs) are associated with impairments in communication, behavior, and social interaction, making accurate diagnosis clinically challenging. Autism Spectrum Disorder (ASD), a major NDD, often exhibits atypical speech patterns characterized by altered prosody and reduced emotional expressiveness. The study proposes a hybrid dual-path framework for ASD detection from emotional speech using two strategies: PCA–GMM-based acoustic modeling and a CNN–BiLSTM–Attention architecture for spectral–temporal feature learning. The proposed framework captures probabilistic, spectral, and temporal speech characteristics for robust ASD classification. Acoustic analysis demonstrated clear separability between ASD and non-ASD speech, while the deep learning framework achieved stable and reliable performance across …

Caregiving And Mental Health Among Mothers During The Covid-19 Pandemic, Makayla Elise Techentine

Walden Dissertations and Doctoral Studies

The 2019 coronavirus (COVID-19) pandemic led to reliance on family members or friends to care for the sick, resulting in a burden of informal caregiving stressors and relationship to mental health. Guided by the stress process model, this quantitative, cross-sectional study aimed to assess the relationship between caregiving stressors and the mental health of mothers of children aged 18 years or younger who were serving as informal caregivers. Secondary data from the 2020-2021 Behavioral Risk Factor Surveillance System (N = 1,772) considered the independent variables related to caregiving stressors, including hours spent caregiving, time since becoming a caregiver, personal care …

Bi-Allelic Loss-Of-Function Variants In Tmem63b Cause Syndromic Surfactant Dysfunction Disorder, Sock Hoai Chan, Audra N Iness, Jill A Rosenfeld, Mir Reza Bekheirnia, Lindsay C Burrage, Matthew Hoi Kin Chau, Chaerish Eint Myet Chae Htoo, Eric C Kao, Shamika Ketkar, Wan Wan Lim, Xi Luo, Rifhan Mazlan, Elizabeth Mizerik, Kein Seong Mun, Kalyani R Patel, Lorraine Potocki, Christina K Rapp, Xavier Roca, Ana Saianda, Ignacio Iglesias-Serrano, Everlyn C Siew, Donald Yuhui Sim, David R Spielberg, Sok-Kun Tae, Jing Xian Teo, Julian Warfsmann, Fan Xia, Child-Eu Registry, Saumya S Jamuar, Ee Shien Tan, Matthias Griese, Weng Khong Lim, Meow-Keong Thong, Keren Machol

Faculty, Staff and Students Publications

Transmembrane protein 63B gene (TMEM63B) encodes a mechanosensitive ion channel expressed in alveolar type II epithelial cells, where it mediates stretch-induced surfactant secretion. While heterozygous gain-of-function variants in TMEM63B have been associated with developmental and epileptic encephalopathy, no human disorder has previously been linked to bi-allelic loss-of-function variants. Here, we report five individuals from four unrelated families with childhood interstitial lung disease and bi-allelic predicted loss-of-function variants in TMEM63B. Affected individuals presented with early-onset respiratory distress, chronic hypoxemia, and diffuse parenchymal lung abnormalities on chest imaging. One individual died in infancy, two underwent bilateral lung transplantation, and two require oxygen …

Behavioral Intentions And Use Of Telehealth Among Afro-Caribbean Immigrants In Florida, Patsy Patricia Lindo-Wood

Walden Dissertations and Doctoral Studies

Many researchers have documented the benefits of telehealth in managing cardiovascular disease and its risk factors. However, acceptance and use of telehealth among immigrants in the United States were low compared to other users, and little is known about Afro-Caribbean immigrants and their telehealth acceptance and use. Guided by the unified theory of acceptance and use of technology, this study explored how performance expectancy, effort expectancy, social influence, and facilitating conditions shape behavioral intentions and telehealth use among Afro-Caribbean immigrants in Port St. Lucie, Florida. A generic qualitative design with a purposive sampling strategy was used to interview 17 Afro-Caribbean …

Leadership-Mediated Retention Strategies To Sustain Workforce Capacity And Performance In Public Health, Meredith Winslow Wilkins

Walden Dissertations and Doctoral Studies

Workforce retention challenges continue to affect public health leaders by contributing to staffing shortages, reduced organizational capacity, and disruptions in service delivery. Public health leaders are concerned with employee turnover because it affects workforce stability, organizational performance, and the ability to meet community health needs. Grounded in Herzberg’s motivation-hygiene theory, the purpose of this qualitative pragmatic inquiry was to explore effective workforce retention strategies used by public health leaders to retain skilled staff and strengthen organizational capacity and revenue. The participants were eight public health leaders in the Northeast region of the United States with responsibility for workforce management and …

Extracellular Vesicle-Mediated Transfer Of Gsdme-Nt Pores As A Mechanism Of Inflammation Propagation, Bifeng Xiao

Master's Theses

Inflammasomes are multiprotein complexes that initiate inflammatory signaling through activation of caspase-1, cytokine maturation, and cleavage of Gasdermin D (GSDMD). Cleaved GSDMD forms membrane pores that contribute to cytokine release and pyroptotic cell death. Recent evidence suggests that extracellular vesicles (EVs) may facilitate the intercellular transfer of inflammatory mediators. This study investigated whether GSDMD N-terminal fragment (GSDMD-NT) associates with EV-enriched fractions and contributes to inflammation propagation. Doxycycline-inducible HeLa cells expressing FLAG-tagged GSDMD-NT were used to generate EV-enriched fractions. Western blot analysis detected GSDMD-NT-associated material within EV fractions, while EV marker analysis supported successful enrichment of EV-associated material. Exposure of recipient …

Benefits Of Pet Friendly Work Environments On Physical, Mental, And Social Health Of Office Workers: A Systematic Review, Ahmed Radwan, Jenna Keeman, Tristan Hunzinger, Owen Wilson, Shayla Seymour

People and Animals: The International Journal of Research and Practice

Background: Pet-friendly workplace initiatives are increasingly common, yet the empirical evidence for benefits to office workers’ physical, mental, and social health is scattered and heterogeneous.

Objective: To synthesize evidence on health-related outcomes associated with pet-friendly work environments for office and desk-based workers, and to appraise the current level of evidence.

Methods: A PRISMA-guided systematic search (2014–2024) was conducted in PubMed, PsycINFO, MEDLINE, OVID, CINAHL, and Google Scholar. Two reviewers independently screened titles/abstracts and full texts, extracted data, and appraised study quality using the Critical Appraisal Skills Program (CASP) checklists. Outcomes were coded and synthesized narratively within three domains: physical, mental, …

The Medicine Forum Crossword, Youssef Elfatatry, Md

The Medicine Forum

ACROSS
1 One leading cause of ACS in young women

DOWN
1 A.O.A. alternative

The Parts They Don’T See, Alexis Notarianni, Md

The Medicine Forum

People think they know what resident doctors do.

They know the obvious parts: we examine patients, prescribe medications, and write notes. We diagnose infections, perform procedures, and coordinate care with nurses. We work long hours and rarely have days off. From the outside, it looks familiar enough to understand.

But there is a large portion of this job that is invisible, even to the people closest to us. It is difficult to explain, and harder still to feel understood unless you are living it.

More Than Medicine: How Advocacy, Education, And Loss Shape The Physician Within, Sheraz Qamar, Md

The Medicine Forum

Illness rarely unfolds in a linear or predictable way. Instead, it emerges through uncertainty – shaped by fragmented symptoms, gaps in access, and the limits of medical knowledge. Reflecting on three deeply personal experiences within my family, I have come to understand my role as a resident physician not only through clinical training, but through lived experience: as an advocate, an educator, and, at times, as someone profoundly affected by loss.

Holding Hands, Alexis Notarianni, Md

The Medicine Forum

My patient had already received the medications we reach for when patients are in pain and afraid — antiemetics, analgesics, and anxiolytics. The nasogastric tube was in place. What remained was not another intervention, but the simple act of being there.

My patient had been healthy until just months earlier, when his life changed abruptly. In the two hundred days since, illness had altered nearly every part of his body. Now he lay in bed in pain, breathing through a tracheostomy, receiving nutrition from a feeding tube. Tears streamed down his cheeks as he reached out and took my hand. …

Good Enough, Anne Leone, Md

The Medicine Forum

(Verse 1)
Coming out the gate a little too fast
This is not sustainable, it won’t last
Can’t turn around, I can’t backtrack
Where do I go from here
How can I maneuver this current

Ripping through and pulling me with it
Going under, air’s running out quick
but the shoreline is near

(Chorus)
Never knew that I could get through a patch so rough,
Never knew before that I was good enough,
The only thing holding me back was my own self doubt,
But I’ll let go now

(Verse 2)
hard to plan what steps to take next now …

An Examination Of Generative Ai In Medicine, J. Marco Cipriaso, Md, Trishya Srinivasan, Md

The Medicine Forum

The age of artificial intelligence (AI) is upon us. Specifically, generative AI has been transforming how we interface with the world by directly generating its own novel output.¹ Medicine is not immune to this change. AI search tools such as OpenEvidence have shown promise by providing evidence-based recommendations, already proven to perform well in primary care settings, with additional promise for future applications.² AI tools have taken over the note-writing process through ambient software, allowing physicians to dedicate more time to face-to-face interaction with their patients.³ These and other developments show clear reason to be excited about …

The Emotional Labor Of Clinicians And The Need For Reflective Support, Benedicta Olonilua, Bs, Evan Nardone, Md

The Medicine Forum

Physicians who work in Palliative Care or adjacent fields like Oncology often bear a unique emotional weight in addition to the typical responsibilities that come with the job. The nature of their work puts them in frequent contact with serious illness, dying, and grief. Additionally, they are often required to engage in conversations that are not only medically complex but also deeply personal and, at times, emotionally charged. While this emotional labor is an inherent part of the job, it can become especially heavy when there is no space to process it. Over time, this can build up and eventually …

Coping As A Team, J. Marco Cipriaso, Md

The Medicine Forum

“Medicine is the only job where someone can die, and you’re expected to go back to work, business as usual.” - Rachael Grosso MD

Methylene Blue As An Adjunctive Therapy In Refractory Septic Shock: A Case-Based Review Of Emerging Evidence, Warda Naqvi, Md, Paulina Lowery, Do, Enad Haddad, Md, Muneeba Ali, Md, Prerana Sevella, Md, Sudeep Nugooru, Md, Richard Friedenheim, Md

The Medicine Forum

Septic shock is associated with high mortality, particularly in patients who develop refractory vasoplegia despite guideline-directed therapy. Excess nitric oxide mediated vasodilation contributes to catecholamine resistance and persistent hypotension. Methylene blue (MB), an inhibitor of nitric oxide synthase and soluble guanylate cyclase, has emerged as a potential adjunctive therapy targeting this pathway. We report a case of a 36-year-old female presenting with severe septic shock secondary to aspiration pneumonia, complicated by profound hypoxemia requiring mechanical ventilation and veno-venous extracorporeal membrane oxygenation. Despite aggressive fluid resuscitation, broad-spectrum antibiotics, corticosteroids, and maximal vasopressor support, she remained hemodynamically unstable. Administration of intravenous MB …

The Intersection Of Ventilator Support And Hospice In Late Als Diagnosis, J. Marco Cipriaso, Md, Kenna Hawes, Md, Margot Noyelle, Md, Megan Cecchine, Md

The Medicine Forum

Amyotrophic lateral sclerosis (ALS) often leads to respiratory failure that can be treated with respiratory support in the form of tracheostomy plus invasive mechanical ventilation. It typically occurs late in the disease course, often allowing patients to adequately prepare by discussing their goals of care. We describe a case of a patient whose ALS was diagnosed after he had TMV initiated. As a result, the patient and family faced a daily decision on when to withdraw ventilator support, and he was unable to achieve his ultimate wish to die at home. We highlight this to recognize that serious illnesses with …

The Back Burn: A Case Report Of Mollaret’S Meningitis In A Young Male, Muneeba Ali, Md, Lubaba Mukhtar, Md, Warda Naqvi, Md, Joseph Hassey, Md, Muhammad Ayub, Md

The Medicine Forum

Mollaret’s syndrome, or benign recurrent aseptic meningitis, is a rare condition characterized by recurrent, self-limited episodes of aseptic meningitis. We present the case of a 49-year-old male with a past medical history of herpes meningitis as a teenager, who presented to the emergency department (ED) with a headache, and whose initial lumbar puncture results were consistent with viral meningitis. HSV-2 was detectable in cerebrospinal fluid (CSF) DNA by PCR but not detected on quantitative PCR. He was diagnosed with Mollaret’s meningitis, and all intravenous antiviral therapy was discontinued, with the patient making a full recovery. This case highlights the important …

Refractory Autoimmune Encephalitis In Metastatic Thymoma, Michael Predi, Do, Anna Bondonese, Md, Anish Vora, Md, Sarah W. Gordon, Do

The Medicine Forum

Thymoma-associated autoimmune encephalitis (TAAE) is a rare paraneoplastic neurological syndrome occurring in approximately 8% of thymoma patients. The condition results from thymic dysfunction leading to impaired T-cell selection and production of autoantibodies against neuronal antigens. Autoimmune encephalitis represents a severe but underrecognized complication with heterogeneous clinical presentations. Thymectomy has been shown to be the most effective treatment for TAAE.

Fever, Cytopenias, And Splenomegaly: A Hematologic Approach To Suspected Hlh In Autoimmune Liver Disease, Reed Firestone, Md, Ms

The Medicine Forum

Fever with cytopenias and splenomegaly raises concern for hematologic malignancy and hyperinflammatory syndromes such as hemophagocytic lymphohistiocytosis (HLH). Distinguishing these entities is critical, as management strategies differ significantly. In this report, we describe a 19-year-old male with autoimmune hepatitis–primary sclerosing cholangitis overlap who presented with one year of recurrent fevers, cytopenias, and splenomegaly. Extensive infectious and malignant workup, including PET imaging and bone marrow biopsy, were negative. HLH was considered; however, laboratory findings were inconsistent, including ferritin of 191 ng/mL and fibrinogen of 683 mg/dL. His course remained chronic and stable. The presentation was attributed to autoimmune liver disease with …

Delayed Immune-Related Ophthalmoplegia After Pembrolizumab Therapy: A Case Report, Mohammed Shah, Md, Smriti Nair, Md, Sarah Sulkowski, Md, Maheen Imran, Bs

The Medicine Forum

We present a case of Pembrolizumab-associated ophthalmoplegia in a patient with HNSCC who previously developed an immune checkpoint inhibitor associated hepatitis. Immune checkpoint inhibitor– associated ocular toxicities are rare, occurring in approximately <1% to 1.1% of treated patients.^1,2 This case highlights the diagnostic challenges of neuroophthalmic immune-related adverse events and the importance of prompt evaluation and immunosuppressive therapy.

Brain On Fire: A Case Of Severe Ifosfamide Encephalopathy And Utilization Of Methylene Blue, Nicholas Spyropoulos, Do, Michelle Joyner, Do

The Medicine Forum

Ifosfamide is a commonly used chemotherapeutic agent indicated for a variety of malignancies; however, given its well-documented complications including Ifosfamide induced encephalopathy (IFE), its overall use is limited. Neurotoxicity secondary to ifosfamide can range from mild confusion to severe neurologic deterioration, with the primary treatment being focused on supportive care. This clinical case highlights a 41-year-old patient with BRAF positive ameloblastic carcinoma who developed acute neurotoxic symptoms following ifosfamide chemotherapy induction. His symptoms, ranging from altered mental status, restlessness, severe headache, and peripheral neuropathy, began shortly after chemotherapy initiation. Both his lab work and imaging could not explain the acute …

Radiographic Imaging Of Power Injectable Medical Access Ports As A Supplemental Identification Tool, Nikhil Goyal, Md, Huy M. Do, Md, Alexandra P. Toscano, Bs, Lillian G. Spear, Bs Georgetown University, Lindsey A. Hazen, Rn, Les R. Folio, Do

The Medicine Forum

Medical access ports (MAPs) are implanted devices often used for intravenous administration of chemotherapeutic agents or contrast agents for CT or MR imaging. Improper MAP usage poses risk of catheter rupture; hence, proper identification and usage are essential. We demonstrate an approach for MAP identification based on their unique radiographic imaging features.

Large Language Models For Detecting Extraprostatic Extension In Free-Text Prostate Mri Radiology Reports, Nikhil Goyal, Md, Satvik Tripathi, Krishnan R. Patel, Md, Mhs, Hyun Tae Kim, Md, Mph, Tessa S. Cook, Md, Phd

The Medicine Forum

Extraprostatic extension (EPE) is a prognostically important pathologic feature of prostate cancer that is difficult to predict preoperatively. Because EPE may be microscopic, it may not be detected with conventional imaging. Several magnetic resonance imaging (MRI) features associated with EPE risk are routinely described in radiology reports and may be detectable by large language models (LLMs). This study evaluated the performance of five commercial LLMs (GPT-3.5-turbo, GPT-4, GPT-4o-mini, GPT-4o, and o3-mini) in classifying pathologic EPE from free-text prostate MRI reports for patients with confirmed prostate cancer. Among the models tested, o3-mini achieved the highest accuracy (66.3%) and positive predictive value …

Reconsidering The Clinical Implications Of Albumin In Severe Acute Pancreatitis, Alexis Notarianni, Md, Jacqueline Krieger, Md

The Medicine Forum

In this single-center pilot trial of 60 ICU patients, early administration of 5% albumin in addition to crystalloid did not significantly improve Systemic Inflammatory Response Syndrome (SIRS) remission at Day 3 nor reduce 60-day mortality.¹ However, a statistically significant reduction in sepsis was observed in the albumin group compared with crystalloid alone (10% vs. 36.7%, P = 0.01). Although the study concludes that albumin did not improve prognosis, we believe the observed difference in sepsis merits further consideration.

Infection and persistent organ failure are well-established determinants of mortality in acute pancreatitis, particularly in the later phases of disease progression. …