Medicine and Health Sciences Commons^™

Punch Cd3-Ols: A Phase 3 Prospective Observational Cohort Study To Evaluate The Safety And Efficacy Of Fecal Microbiota, Live-Jslm (Rebyota) In Adults With Recurrent Clostridioides Difficile Infection, Paul Feuerstadt, Teena Chopra, Whitfield Knapple, Nicholas W Van Hise, Erik R Dubberke, Brian Baggott, Beth Guthmueller, Lindy Bancke, Michael Gamborg, Theodore S Steiner, Daniel Van Handel, Sahil Khanna

2020-Current year OA Pubs

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of fecal microbiota, live-jslm (RBL; REBYOTA)-the first single-dose, broad consortia microbiota-based live biotherapeutic approved by the US Food and Drug Administration for preventing recurrent Clostridioides difficile infection (rCDI) in adults following standard-of-care (SOC) antibiotic treatment.

METHODS: PUNCH CD3-OLS was a prospective, phase 3, open-label study, conducted across the US and Canada. Participants were aged ≥18 years with documented rCDI and confirmed use of SOC antibiotics. Participants with comorbidities including inflammatory bowel disease and mild-to-moderate immunocompromising conditions could be enrolled. A single dose of RBL was rectally administered …

Priming For Practice: A Teaching Strategy, Jennifer Tomesko, Diane L. Rigassio Radler

Journal of Dietetic Education

Authors present a brief educational teaching strategy.

Use Of Simulation In Dietetic Internships: A Qualitative Exploration Of Program Director Attitudes And Motivations, Theresa B. O'Reilly, Amy J. Nwora, Megan Whelan, Mary-Pat Maciolek

Journal of Dietetic Education

The use of simulation holds promise for the future of dietetics education for its use as an alternative for up to 30% of the 1,000 supervised practice hours for the training of Registered Dietitian Nutritionists. Even more so, simulation is a teaching tool. When done well, simulation can challenge students in a safe environment where they can receive constructive feedback from expert guides and meaningfully reflect on their learning. The purpose of this study was to interview dietetic internship (DI) program directors on their attitudes and motivations on the use of simulation in their programs, targeting the heavily program-congested states …

Conceptual Diagrams Help Dietetic Students To Understand And Apply The Nutrition Care Process, Janica Jamieson, Bojana Kovacic, Philippa Lyons-Wall, Therese O'Sullivan

Journal of Dietetic Education

Aim: To evaluate the impact of a conceptual diagram assessment task on dietetic student knowledge of and confidence applying the Nutrition Care Process. Methods: Situated within a pragmatic research paradigm, this mixed methods study applied a survey administered before and after a conceptual diagram assessment task using the Nutrition Care Process to explore changes in student knowledge, self-reported confidence, perceptions towards the Nutrition Care Process, and student experience. Nineteen students enrolled in a first-semester unit within a Master level dietetic course completed the assessment task, which visually presented a client case sourced from the student-run clinic within the Nutrition Care …

Cover, Editor's Message, Table Of Contents, Diana Cuy Castellanos

Journal of Dietetic Education

No abstract provided.

The Usefulness Of 3d Heart Models As A Tool Of Congenital Heart Disease Education: A Narrative Review, Raghad Abdulaziz Alhojailan, Reghd Husain M Alkhalifah, Bana Albani, Majed Wadi

Journal of the Saudi Heart Association

Objectives: The objective of this review is to evaluate the effectiveness of three-dimensional (3D) heart models as teaching tools for congenital heart disease (CHD), addressing the limitations of traditional medical education methods. Methods: A thorough literature review was conducted using PubMed, Google Scholar, Scientific Direct and Scopus databases. Relevant articles were screened and selected based on their discussion of the application of 3D models in CHD education. Results: The comprehensive review of 19 studies revealed that 3D heart models provide students, healthcare professionals, and patients with meaningful experiences that significantly enhance understanding and learning outcomes. These models improve …

Advances In 2024: Update And Thanking Our Peer Reviewers, Richard Alweis, Christina Goodermote, Elizabeth Mamo

Advances in Clinical Medical Research and Healthcare Delivery

The Editors review the performance of the journal and thank the peer reviewers for 2024.

Monroe County Medical Society Abstract Competition, Janine Fogarty

Advances in Clinical Medical Research and Healthcare Delivery

Established in 1821 in Rochester, New York, Monroe County Medical Society is a non-profit, professional organization whose 1,200 members are physicians, residents, and medical students. The society advocates for physicians and patients for the betterment of the medical profession and the health of the community. Monroe County Medical Society encompasses the 7th District Branch of the Medical Society of the State of New York and serves the New York State counties of Monroe, Livingston, Ontario, Seneca, Steuben, Wayne & Yates Counties

A call for abstracts was requested for the Monroe County Medical Society 203rd Anniversary Gala held on September 25th, …

Murder Mystery Solved! Unmasking Multi-Generational Familial Death As A Result Of Brugada Syndrome, Ryan Tam, Sandres Aodish, Jeremiah Tom, Mohammad Jawish

Advances in Clinical Medical Research and Healthcare Delivery

Brugada syndrome is an inherited condition that has an increased risk of developing ventricular arrhythmias and sudden cardiac death. This condition can be diagnosed by using the Shanghai Scoring System. Here, we present a patient with an incidental finding of Type 1 Brugada pattern on electrocardiogram amidst atypical neurological findings on presentation to the emergency department and a history of cardiac-related familial deaths of uncertain etiology.

One Center's Experience Of Pulmonary Embolism After Covid-19: Impact Of Vaccination Status, Cara Gose, Kaylee Dixon, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background: The incidence of pulmonary embolism (PE) has increased since the outbreak of the COVID-19 pandemic and may be due to the observed hypercoagulable state. There is conflicting evidence that thromboembolism risk increases after vaccination and that vaccines decrease the probability of having a thromboembolic event. This study aimed to explore how vaccination status impacts occurrence of PE after a positive COVID-19 test. The hypothesis was that vaccinated, immunocompetent patients have a lower incidence of PE after COVID-19 compared to unvaccinated patients.

Methods: This was a retrospective chart review at a teaching hospital in New England from 1/01/2021 to 3/31/2023 …

A Compelling Case Of The Use Of Electroconvulsive Therapy In Severe Treatment Resistant Depression With Suicidality, Neha Narayanan, Ryan Tam, James Mead

Advances in Clinical Medical Research and Healthcare Delivery

Treatment-resistant depression is a condition that occurs when an individual, experiencing major depressive disorder episodes, has failed the first line of treatment with medication therapy of adequate dose and duration. This is important to be addressed as there is a high likelihood of progression to having thoughts and an intended plan for suicide. Electroconvulsive therapy is a recommended option for those who have failed medication therapy, but it has been controversial in its use due to its stigma and side effects of memory impairment. Here, we present a case of a patient who had undergone several sessions of ECT with …

Special Patient Populations - A Case Report Of A Jehovah’S Witness, Michael P. Mullinax, S. Jiaming Lin, Paige M. Kieper, Jake W. Vogel, Orlando Nunez Isaac

Advances in Clinical Medical Research and Healthcare Delivery

This case report describes a Jehovah’s Witness patient with a life-threatening exacerbation of chronic anemia, warranting blood transfusion. This case highlights the complex medical management and ethical considerations encountered when treating special patient populations. Moreover, this case illustrates the delicate balance that healthcare providers must maintain when delivering necessary medical interventions to patients with competing religious beliefs.

Enfortumab Vedotin Induced Cutaneous Manifestations, Zeni Kharel, Farhan S. Imran

Advances in Clinical Medical Research and Healthcare Delivery

Enfortumab vedotin(EV) comprises of an anti–nectin-4 monoclonal antibody bound to the chemotherapeutic agent called monomethyl auristatin E, forming an antibody-drug conjugate. It is currently approved for the treatment of locally advanced or metastatic urothelial carcinoma after disease progression on two prior lines of therapy including chemotherapy and immunotherapy. Since nectin-4 is also expressed on the surface of keratinocytes, cutaneous adverse effects are common. Our clinical image depicts a cutaneous adverse reaction to EV and its resolution after discontinuation of EV.

Coexisting Renal Artery Stenosis And Large Angiomyolipoma In A Solitary Kidney: A Therapeutic Dilemma, Yohannes B. Tilahun, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

Title: Coexisting Renal Artery Stenosis and Large Angiomyolipoma in a Solitary Kidney: A Therapeutic Dilemma

Authors: Tilahun YB, Mentor/Attending: Sekar A

Background: Angiomyolipomas (AMLs) are the most common benign renal tumors, typically presenting as incidental findings. However, large AMLs can lead to life-threatening complications such as retroperitoneal hemorrhage, particularly in the setting of a solitary kidney. The presence of concomitant renal artery stenosis (RAS) further complicates management, posing a unique therapeutic challenge in balancing the need to prevent hemorrhage, preserve renal function, and optimize renovascular perfusion.

Case: A 77-year-old African American woman with a history of left nephrectomy for renal …

Unilateral Hearing Loss Caused By Bilateral Otosclerosis In The Context Of Prior Viral Infection - Case Report, Ryan Tam, Michael Mullinax, Timothy Ehmann, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

This is a case report of a patient who presented with left sided hearing loss. The patient was found to have mixed conductive and sensorineural hearing loss of the left ear and restrictive hearing of the right ear. Subsequent imaging demonstrated evidence of bilateral otosclerosis. Otosclerosis is characterized by progressive pathological bone remodeling in the otic capsule, resulting in hearing loss. Given the disease burden of otosclerosis and the corresponding effects on quality of life, providers must have knowledge of the disease to incorporate it into working differential diagnoses for patients presenting with hearing loss. With increasing recognition of otosclerosis …

Improving Vitamin B12 Monitoring In Metformin-Treated Patients: A Quality Improvement Project, Himal Kharel, Zeni Kharel, Abdullah A. Orakzai, Aditya Sanjeevi, Prajjwol D. Bhatta, Ali S. Mohamed, Tripti Jain, Aniket-Vijay Rao, Daniel Idoate Domench, Mouna Reghis, Hassan Saeed

Advances in Clinical Medical Research and Healthcare Delivery

Background: Although periodic vitamin B12 monitoring is recommended for patients on chronic metformin therapy, the recommendation is not adequately followed. Similar quality improvement project in the past had failed due to ongoing COVID-19 pandemic.

Objectives: The main objective of this study is to evaluate the impact of focused educational lectures on vitamin B12 screening rates. Our target study population included diabetics and prediabetics on chronic metformin therapy.

Design: Quality improvement pre-post design

Participants: Internal Medicine residents

Intervention: Educational sessions on the importance of vitamin B12 screening in this population

Outcomes: Proportion of patients undergoing vitamin B12 screening pre and post-intervention …

Clozapine Induced Eosinophilic Pleural Effusion With Peripheral Eosinophilia After Two Years: A Case Report And Literature Review, Emiliya Boriskina, Christopher J. Etterle

Advances in Clinical Medical Research and Healthcare Delivery

There has been a steady increase in reports of clozapine causing eosinophilic pleural effusions (EPEs). For an effusion to be classified as eosinophilic it must have greater than 10% eosinophils, and is commonly associated with peripheral eosinophilia. Numerous etiologies exist for EPEs, and symptoms include dry cough, fever, chest pain, shortness of breath, and acute to chronic sputum production. The effusions are usually exudative and unilateral. When considering medication-induced EPEs, an extensive work-up should be done as it is a diagnosis of exclusion. If suspected, then the Naranjo probability scale can be applied. Despite the growing list of implicated medications, …

Anatomy And Variations Of The Carina And Its Cartilaginous Makeup: A Cadaveric Study, Chung Yoh Kim, Kristen Rizzuto, Daniel Tahan, Devendra Shekhawat, Rarinthorn Samrid, Yoko Tabira, Stephen J. Bordes, Joe Iwanaga, R. Shane Tubbs

School of Medicine Faculty Publications

Purpose: The carina, located at the bifurcation of the trachea, has been regarded as a part of the trachea. Although clinically useful as an anatomical landmark, studies of its detailed morphology are lacking in the literature. Methods: The distal trachea and left and right main bronchi were harvested from 32 cadavers and the carina studied using microsurgical dissection, endoscopy, micro-CT, and histology. Results: The right bronchial cartilages were most commonly involved in forming the carina (72.41%), and the left bronchial cartilages were the second most commonly involved (37.93%). The carinal cartilages were slightly deviated to the left of midline in …

Durable Responses To Immune Checkpoint Inhibitor-Based Regimens For Metastatic Clear Cell Renal Cell Carcinoma Stratified By Imdc Risk Groups: A Pooled Analysis Of Four Randomized Phase 3 Trials, Albert Jang, Jeffrey Y. Zhong, Hamsa L.S. Kumar, Kevin K. Zarrabi, Alec Zhu, Abby L. Grier, Adam Calaway, Jonathan E. Shoag, Laura Bukavina, Angela Y. Jia, Prateek Mendiratta, Iris Y. Sheng, Santosh Rao, Jason R. Brown, Jorge A. Garcia, Seunghee Margevicius, Pingfu Fu, Pedro C. Barata

Department of Medical Oncology Faculty Papers

Background: An immune checkpoint inhibitor (ICI) backbone is a standard of care for frontline metastatic clear cell renal cell carcinoma, involving either ICI doublet or tyrosine kinase inhibitor (TKI) with ICI. These phase 3 trials used a sunitinib control arm. The optimal regimen is uncertain. Objective: To compare long-term responders of these trials using extended follow-up data stratified by International Metastatic RCC Database Consortium risk group. Methods: Phase 3 trial data (CheckMate 214, KEYNOTE-426, CheckMate 9ER, and CLEAR) with a minimum follow-up of four years was used. Pseudo individual patient data (IPD) was obtained from Kaplan-Meier curves using the graph …

Behavioral Science-Based “Nudges” Could Increase Physical Activity Among Adolescents With Adhd, Hannah Patnaik, Andrew S. London, Kevin M. Antshel

Population Health Research Brief Series

Children and adolescents with ADHD are more likely to exhibit difficulties in school, have higher rates of injuries and accidents and more family conflicts, and are at higher risk of depression and anxiety. Given the prevalence of ADHD and associated difficulties, there is a substantial need for effective ADHD treatment and symptom management. This brief summarizes findings from a recently completed pilot study testing the efficacy of behavioral interventions aimed at encouraging daily physical activity (i.e., steps measured with an activity tracker) among adolescents with ADHD in the Syracuse, NY area between March 2023 and June 2024. Results show that …

It Ain’T Easy Bein’ Wheezy: A Review And Updates On Asthma, Christina Bach

Unity Hospital Grand Rounds

It Ain’t Easy Bein’ Wheezy: A Review and Updates on Asthma. Christina Bach, MD

Objectives:

• Review that asthma is not a static diagnosis and needs constant re-evaluation
• Will address new guidelines in asthma in the last few years with significant change in initiation of therapy
• Examine new add-on therapies available for uncontrolled asthma
• Evaluate patients for asthma and appropriately initiate and manage treatment based on current practice guidelines
• Recognize new add-on therapies for asthma, how they work, and when to utilize them

Dataset For Comparative Analysis Of Precision Metagenomics And Traditional Methods In Urinary Tract Infection Diagnostics, Rob E. Carpenter, Sadia Almas, Vaibhav Tamrakar, Rahul Sharma

Human Resource Development Faculty Publications and Presentations

This study presents a comprehensive dataset comparing three diagnostic methodologies—microbial culture, polymerase chain reaction (PCR), and precision metagenomics (precision metagenomics)—for the detection and classification of uropathogens in urine samples from patients with suspected urinary tract infections (UTIs). While microbial culture remains the gold standard for UTI diagnosis, it has limitations in sensitivity, particularly for fastidious or non-culturable microorganisms. PCR offers higher sensitivity but is restricted to pre-targeted organisms, limiting its diagnostic range. Precision Metagenomics, a target-agnostic sequencing method, provides a more inclusive approach by enabling the identification of a broad spectrum of pathogens, including bacteria, viruses, fungi, and parasites, without …

The Road Ahead: Emerging Therapies For Primary Iga Nephropathy, Edward J. Filippone, Rakesh Gulati, John Farber

Division of Nephrology Faculty Papers

Primary IgA nephropathy (IgAN) is the most common form of primary glomerulopathy. A slowly progressive disease presenting in the young to middle-aged, most patients with reduced eGFR or proteinuria will progress to end-stage kidney disease (ESKD) in their lifetimes. The pathogenesis involves increased production of galactose-deficient IgA1 (Gd-IgA1) that forms immune complexes that deposit in the glomerulus, eliciting mesangial cell proliferation, inflammation, and complement activation. The backbone of therapy is supportive, including lifestyle modifications, strict blood pressure control, and renin-angiotensin system inhibition targeting proteinuria < 300 mg/day. Sodium-glucose transporter 2 inhibitors are indicated for persisting proteinuria or declining eGFR. Sparsentan is indicated for persisting proteinuria. Immunosuppression should be considered for all patients at risk for progression (persisting proteinuria and/or declining eGFR). To reduce Gd-IgA1 production, targeted-release budesonide is approved. Agents targeting B cell survival factors APRIL or BAFF/APRIL have significantly reduced Gd-IgA1 production and proteinuria in phase 2 trials but await phase 3 data for approval. To reduce inflammation, high-dose steroids are ineffective and toxic in Caucasian patients, although lower-dose regimens may be effective in Chinese patients. Complement inhibition is being actively studied. The factor B inhibitor iptacopan has conditional approval. The terminal pathway inhibitors cemdisiran and ravulizumab show promise in phase 2 studies. Our current approach for those requiring immunosuppression involves combining the reduction of Gd-IgA1 (nefecon) with suppressing the effects of inflammation (iptacopan). The optimal duration of such therapy is uncertain. Clearly, there is more to be learned with many trials underway.

The Role Of Molecular Profiling In De-Escalation Of Toxic Therapy In Breast Cancer, Sonia Y. Khan, Tonjeh Bah, Rakhshanda Layeequr Rahman

School of Medicine Publications

The prevalence and mortality associated with breast cancer have forced healthcare providers to leverage surgery, chemotherapy, radiation therapy, and immunotherapy to achieve a cure. Whereas mortality has significantly dropped over the decades, long-term toxicities and healthcare costs are prohibitive. Therefore, a better understanding of tumor biology through molecular profiling is being utilized for de-escalation of treatment where appropriate. As research evolves, there is growing evidence that less aggressive treatment regimens, when appropriately tailored, can be equally effective for certain patient populations. This approach not only enhances the quality of life for patients by reducing the financial, physical, and emotional burdens …

Prediction Of Obstructive Coronary Artery Disease Using Coronary Calcification And Epicardial Adipose Tissue Assessments From Ct Calcium Scoring Scans, Juhwan Lee, Tao Hu, Ammar Hoori, Hao Wu, Justin N. Kim, Robert Gilkeson, Sanjay Rajagopalan, David L. Wilson

Faculty Scholarship

Background: Low-cost/no-cost non-contrast CT calcium scoring (CTCS) exams can provide direct evidence of coronary atherosclerosis. In this study, using features from CTCS images, we developed a novel machine learning model to predict obstructive coronary artery disease (CAD), as defined by the coronary artery disease-reporting and data system (CAD-RADS). Methods: This study analyzed 1324 patients from the SCOT-HEART trial who underwent both CTCS and CT angiography. Obstructive CAD was defined as CAD-RADS 4A-5, while CAD-RADS 0–3 were considered non-obstructive CAD. We analyzed clinical, Agatston-score-derived, and epicardial fat-omics features to predict obstructive CAD. The most predictive features were selected using elastic net …

Celebrating World Cancer Day: Innovative Biological Approaches To Cancer And Their Alignment With Sustainable Development Goals (Sdgs), Hamed Kioumarsi, Bolin Liu

School of Medicine Faculty Publications

No abstract provided.

Impact Of Coronavirus Disease 2019 On Dental Match Residency Applicant Statistics In The United States Of America: A Cross Sectional Analysis, Vinayak M. Joshi, Eswar Kandaswamy, Sivaraman Prakasam, Veerasathpurush Allareddy, Andrew G. Chapple

School of Dentistry Faculty Publications

Background: The purpose of this paper is to do a cross-sectional analysis to evaluate the impact of the Coronavirus Disease 2019 pandemic on Dental Match Residency statistics from the year 2019–2023. Methods: The Dental Match Residency statistics available from the Dental Match website were analyzed from years 2019–2023 to evaluate the impact of pre-pandemic (2019–2020), pandemic (2021, 2022) and post-pandemic year trends (2023). Important trends were evaluated and summarized using graphs, descriptive statistics, and two sample tests for proportions (chi-square test) comparing different pairs of years. Results: Total Match participants increased in 2021 followed by a drop in 2022, and …

The Misalignment Of Incentives In Academic Publishing And Implications For Journal Reform, Jennifer S Trueblood, David B Allison, Sarahanne M Field, Ayelet Fishbach, Stefan D M Gaillard, Gerd Gigerenzer, William R Holmes, Stephan Lewandowsky, Dora Matzke, Mary C Murphy, Sebastian Musslick, Vencislav Popov, Adina L Roskies, Judith Ter Schure, Andrei R Teodorescu

Children’s Nutrition Research Center Staff Publications

For most researchers, academic publishing serves two goals that are often misaligned-knowledge dissemination and establishing scientific credentials. While both goals can encourage research with significant depth and scope, the latter can also pressure scholars to maximize publication metrics. Commercial publishing companies have capitalized on the centrality of publishing to the scientific enterprises of knowledge dissemination and academic recognition to extract large profits from academia by leveraging unpaid services from reviewers, creating financial barriers to research dissemination, and imposing substantial fees for open access. We present a set of perspectives exploring alternative models for communicating and disseminating scientific research. Acknowledging that …

Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis In The Management Of Intermediate-Risk Pulmonary Embolism: Primary Results Of The Peerless Randomized Controlled Trial, Wissam Jaber, Carin Gonsalves, Stefan Stortecky, Samuel Horr, Orestis Pappas, Ripal Gandhi, Keith Pereira, Jay Giri, Sameer Khandhar, Khawaja Afzal Ammar, David Lasorda, Brian Stegman, Lucas Busch, David Dexter, Ezana Azene, Nikhil Daga, Fakhir Elmasri, Chandra Kunavarapu, Mark Rea, Joseph Rossi, Joseph Campbell, Jonathan Lindquist, Adam Raskin, Jason Smith, Thomas Tamlyn, Gabriel Hernandez, Parth Rali, Torrey Schmidt, Jeffrey Bruckel, Juan Camacho, Jun Li, Samy Selim, Catalin Toma, Sukhdeep Singh Basra, Brian Bergmark, Bhavraj Khalsa, David Zlotnick, Jordan Castle, David O'Connor, C. Michael Gibson

Department of Radiology Faculty Papers

BACKGROUND: There are a lack of randomized controlled trial data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism.

METHODS: PEERLESS is a prospective, multicenter, randomized controlled trial that enrolled 550 patients with intermediate-risk pulmonary embolism with right ventricular dilatation and additional clinical risk factors randomized 1:1 to treatment with large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT). The primary end point was a hierarchal win ratio composite of the following (assessed at the sooner of hospital discharge or 7 days after the procedure): (1) all-cause mortality, (2) intracranial hemorrhage, (3) major bleeding, (4) clinical deterioration and/or escalation to …

The Association Between Online Health Information Characteristics And Appropriate Trust In Informational Quality Among Patients With High Cardiovascular Risk, Lim Woei Xian

Student Works (2020-2029)

More patients are turning to the Internet to understand their health and make health decisions. However, the quality of online health information (OHI) is highly variable, and it may contain misinformation. Patients who lack the necessary skills to appraise OHI may trust poor-quality OHI. Thus, this study aims to examine the association between OHI characteristics and appropriate trust in patients with high cardiovascular (CV) risk. This is a secondary analysis from a quantitative cohort study of 270 patients from a primary care clinic in Kuala Lumpur, Malaysia. Patients recorded each OHI encountered over two months in a digital information diary …