Diseases Commons^™

Dietary Acculturation Is Associated With Altered Gut Microbiome, Circulating Metabolites, And Cardiovascular Disease Risk In Us Hispanics And Latinos: Results From Hchs/Sol, Yi Wang, Guo-Chong Chen, Zheng Wang, Kai Luo, Yanbo Zhang, Yang Li, Amanda C Mcclain, Marta M Jankowska, Krista M Perreira, Josiemer Mattei, Carmen R Isasi, Maria M Llabre, Bharat Thyagarajan, Martha L Daviglus, Linda Van Horn, David Goldsztajn Farelo, Luis E Maldonado, Steven R Levine, Bing Yu, Eric Boerwinkle, Rob Knight, Robert D Burk, Robert C Kaplan, Qibin Qi, Brandilyn A Peters

Faculty, Staff and Student Publications

Background: Dietary acculturation, or adoption of dominant culture diet by migrant groups, influences human health. We aimed to examine dietary acculturation and its relationships with cardiovascular disease (CVD), gut microbiota, and blood metabolites among US Hispanic and Latino adults.

Methods: In the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), US exposure was defined by years in the United States (50 states and Washington, DC) and US nativity. A dietary acculturation pattern was derived from 14 172 participants with two 24-hour dietary recalls at baseline (2008-2011) using least absolute shrinkage and selection operator regression, with food groups as predictors of US …

Rare Causes Of Gastrointestinal Hemorrhage: A Case Series Of Adult Duodenal And Jejunal Gastric Heterotopia, Venkata Vinod Matli, John Kirkikis, Gregory Wellman, Dustin Hadley, Ross M. Dies, David F. Dies

School of Medicine Faculty Publications

Gastric heterotopia (GH) is a rare cause of gastrointestinal bleeding. GH of the small bowel is rare, and the duodenum is more commonly involved than the jejunum. Here, we present five cases of GH involving the duodenum and jejunum, with presentations including gastrointestinal bleeding, symptomatic anemia, and no symptoms. A 63-year-old man presented with melenic stools but could not identify an obvious bleeding source during endoscopy. He was ultimately diagnosed with jejunal GH. A 70-year-old woman with melena and severe anemia had a duodenal bulb mass detected during endoscopy, which was histopathologically diagnosed as GH. A 54-year-old woman experienced nausea, …

A Presentation Of Acute On Chronic Pancreatitis Complicated By Pancreaticopleural Fistula Leading To Bilateral Exudative Pleural Effusions And Empyema, Ashruta Patel, Do, Ms

The Journal of Integrated Primary Care

This case report highlights a rare but serious complication of acute pancreatitis, where pancreatic juice drains into the pleural space, causing bilateral exudative pleural effusions and potentially leading to empyema. The patient's history of alcohol abuse and splenic vein thrombosis likely contributed to the development of this complication. The clinical presentation, including progressive shortness of breath and pleuritic chest pain, along with findings on examination and imaging, prompted further investigation. The MRI findings of a pancreaticopleural fistula, along with a pseudocyst, were significant in diagnosing the condition. Treatment involved a multidisciplinary approach, including antibiotic therapy, chest tube placement to drain …

Histopathology Imaging And Clinical Data Including Remission Status In Pediatric Inflammatory Bowel Disease, Chloe Martin-King, Ali Nael, Louis Ehwerhemuepha, Blake Calvo, Quinn Gates, Jamie Janchoi, Elisa Ornelas, Melissa Perez, Andrea Venderby, John Miklavcic, Peter Chang, Aaron Sassoon, Kenneth Grant

Food Science Faculty Articles and Research

The incidence of inflammatory bowel disease (IBD) is increasing annually. Children with IBD often suffer significant morbidity due to physical and emotional effects of the disease and treatment. Corticosteroids, often a component of therapy, carry undesirable side effects with long term use. Steroid-free remission has become a standard for care-quality improvement. Anticipating therapeutic outcomes is difficult, with treatments often leveraged in a trial-and-error fashion. Artificial intelligence (AI) has demonstrated success in medical imaging classification tasks. Predicting patients who will attain remission will help inform treatment decisions. The provided dataset comprises 951 tissue section scans (167 whole-slides) obtained from 18 pediatric …

Disappearing Dysphagia And The Spontaneous Intraesophageal Hematoma, A Wayne Wheeler, Stephen Landreneau

School of Medicine Faculty Publications

No abstract provided.

Developing The Openflexure Microscope Towards Medical Use: Technical And Social Challenges Of Developing Globally Accessible Hardware For Healthcare, Joe Knapper, Freya Whiteford, Daniel Rosen, William Wadsworth, Julian Stirling, Catherine Mkindi, Joram Mduda, Valerian L Sanga, Paul T Nyakyi, Thomas Hervé Mboa Nkoudou, Elisée Jafsia, Stephane Fadanka, Kelsey Hummel, Sharmila Anandasabapathy, Richard Bowman

Faculty, Staff and Students Publications

The OpenFlexure Microscope is an accessible, three-dimensional-printed robotic microscope, with sufficient image quality to resolve diagnostic features including parasites and cancerous cells. As access to lab-grade microscopes is a major challenge in global healthcare, the OpenFlexure Microscope has been developed to be manufactured, maintained and used in remote environments, supporting point-of-care diagnosis. The steps taken in transforming the hardware and software from an academic prototype towards an accepted medical device include addressing technical and social challenges, and are key for any innovation targeting improved effectiveness in low-resource healthcare. This article is part of the Theo Murphy meeting issue 'Open, reproducible …

Antitumor Effects Of Resveratrol Opposing Mechanisms Of Helicobacter Pylori In Gastric Cancer, Daniela Trautmann, Francesca Suazo, Keila Torres, Layla Simón

Faculty, Staff and Student Publications

Gastric cancer is an aggressive and multifactorial disease. Helicobacter pylori (H. pylori) is identified as a significant etiological factor in gastric cancer. Although only a fraction of patients infected with H. pylori progresses to gastric cancer, bacterial infection is critical in the pathology and development of this malignancy. The pathogenic mechanisms of this bacterium involve the disruption of the gastric epithelial barrier and the induction of chronic inflammation, oxidative stress, angiogenesis and metastasis. Adherence molecules, virulence (CagA and VacA) and colonization (urease) factors are important in its pathogenicity. On the other hand, resveratrol is a natural polyphenol with …

Sump Syndrome: The Forgotten Cause Of Painless Jaundice In The Elderly, Mark Ayoub, Amna Anees

Journal of Community Hospital Internal Medicine Perspectives

Painless jaundice is a common presentation of abdominal malignancy seen in elderly patients. While malignancy may be a common cause of obstructive jaundice in that population group, anchor bias should always be avoided. We present a case of an elderly woman who presented with painless jaundice and weight loss. She had a very remote history of cholecystitis. She was found to have Sump syndrome due to a stricture at the Choledochoduodenostomy (CDD) site. She underwent endoscopic retrograde cholangiopancreatography (ERCP) with stent placement which shortly led to resolution of her jaundice. Biopsy from the stricture site came back negative for malignancy.

Origins Of Cancer: Ain’T It Just Mature Cells Misbehaving?, Charles J Cho, Jeffrey W Brown, Jason C Mills

Faculty, Staff and Students Publications

A pervasive view is that undifferentiated stem cells are alone responsible for generating all other cells and are the origins of cancer. However, emerging evidence demonstrates fully differentiated cells are plastic, can be coaxed to proliferate, and also play essential roles in tissue maintenance, regeneration, and tumorigenesis. Here, we review the mechanisms governing how differentiated cells become cancer cells. First, we examine the unique characteristics of differentiated cell division, focusing on why differentiated cells are more susceptible than stem cells to accumulating mutations. Next, we investigate why the evolution of multicellularity in animals likely required plastic differentiated cells that maintain …

Optimization Of Kidney Health In Liver Transplant Candidates: Pretransplant Considerations And Modalities, Muhammad Y Jan, Kavish R Patidar, Marwan S Ghabril, Chandrashekhar A Kubal

Faculty, Staff and Students Publications

Patients with decompensated end-stage liver disease (ESLD) are at increased risk for mortality, and only liver transplantation (LT) offers meaningful hope for survival. These patients are at risk for kidney dysfunction through the continuum of care for ESLD including LT. We discuss the role of accurate estimation and measurement of baseline glomerular filtration rate in assessment of kidney dysfunction among those with ESLD. Optimizing kidney function is a vital goal in the management of these patients before LT. In this review, we summarize salient aspects of assessing and optimizing kidney function in this patient population. Precipitating factors and different causes …

Controversies In Terlipressin And Transplantation In The United States: How Do We Meld The Two?, Eric M Przybyszewski, Robert M Wilechansky, Paige Mclean Diaz, Andrew S Allegretti, Lisa B Vanwagner, Giuseppe Cullaro, Josh Levitsky, Pere Ginès, Salvatore Piano, Sumeet K Asrani, Kavish R Patidar, Hrs-Harmony Consortium

Faculty, Staff and Students Publications

Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a severe complication of cirrhosis that carries a poor prognosis. The recent Food and Drug Administration approval of terlipressin has substantial implications for managing HRS-AKI and liver allocation in the United States. Terlipressin has been available in Europe for over a decade, and several countries have adapted policy changes such as Model for End-Stage Liver Disease (MELD) score "lock" for HRS-AKI. In this article, we outline the European experience with terlipressin use and explore the question of whether terlipressin treatment for HRS-AKI should qualify for the MELD score "lock" in the United States in …

Learning Curve For Endoscopic Submucosal Dissection (Esd) In The United States: Large, Untutored, Single-Operator Experience, Mai A Khalaf, Fares Ayoub, Kristen A Staggers, Johanna W El-Haj, Salmaan Jawaid, Mohamed O Othman

Faculty, Staff and Students Publications

Background and study aims Endoscopic submucosal dissection (ESD) allows removal of tumors en-bloc. Western adoption of ESD has been hindered by its steep learning curve. Western data regarding ESD learning curve are limited. We analyzed the learning curve of a single endoscopist at a tertiary referral center in the United States.

Patients and methods All consecutive ESDs performed by a single endoscopist at a tertiary referral center in the United States from 2015 through 2022 were identified. Descriptive statistics and CUSUM analysis were used to describe the learning curve for en-bloc, R0 resection, and resection speed.\

Results In our study, …

Bile Acids Differentially Regulate Longitudinal Smooth Muscle Contractility In Everted Mouse Ileum, Peace N Dike, Krishnakant G Soni, Diana S Chang, Geoffrey A Preidis

Faculty, Staff and Students Publications

Bile acids regulate gastrointestinal motility by mechanisms that are poorly understood. Standard isolated tissue bath assays might not recapitulate in vivo physiology if contractile responses to certain bile acids require direct application to the intestinal mucosa. We sought to determine the feasibility of quantifying longitudinal smooth muscle contractile responses to bile acids from intact segments of everted mouse ileum. Ileum from adult female C57BL/6J mice was isolated, gently everted over a notched metal rod, and mounted in tissue baths. Individual bile acids and agonists of bile acid receptors were added to the baths, and longitudinal smooth muscle contractile responses were …

The Time-Dependent Association Between Irritable Bowel Syndrome And All-Cause And Cause-Specific Mortality: A Prospective Cohort Study Within The Uk Biobank, Fangyu Li, Yukiko Yano, Lola Étiévant, Carrie R Daniel, Shreela V Sharma, Eric L Brown, Ruosha Li, Erikka Loftfield, Qing Lan, Rashmi Sinha, Baharak Moshiree, Maki Inoue-Choi, Emily Vogtmann

Faculty, Staff and Student Publications

Introduction: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, but few studies have evaluated mortality risks among individuals with IBS. We explored the association between IBS and all-cause and cause-specific mortality in the UK Biobank.

Methods: We included 502,369 participants from the UK Biobank with mortality data through 2022. IBS was defined using baseline self-report and linkage to primary care or hospital admission data. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality using multivariable Cox proportional hazards regression models within partitioned follow-up time categories (0-5, >5-10, and >10 …

Global Prevalence Of Metabolic Dysfunction-Associated Fatty Liver Disease-Related Hepatocellular Carcinoma: A Systematic Review And Meta-Analysis, Harry Crane, Guy D Eslick, Cameron Gofton, Anjiya Shaikh, George Cholankeril, Mark Cheah, Jian-Hong Zhong, Gianluca Svegliati-Baroni, Alessandro Vitale, Beom Kyung Kim, Sang Hoon Ahn, Mi Na Kim, Simone I Strasser, Jacob George

Faculty, Staff and Students Publications

BACKGROUND/AIMS: The global proportion of hepatocellular carcinoma (HCC) attributable to metabolic dysfunction-associated fatty liver disease (MAFLD) is unclear. The MAFLD diagnostic criteria allows objective diagnosis in the presence of steatosis plus defined markers of metabolic dysfunction, irrespective of concurrent liver disease. We aimed to determine the total global prevalence of MAFLD in HCC cohorts (total-MAFLD), including the proportion with MAFLD as their sole liver disease (single-MAFLD), and the proportion of those with concurrent liver disease where MAFLD was a contributary factor (mixed-MAFLD).

METHODS: This systematic review and meta-analysis included studies systematically ascertaining MAFLD in HCC cohorts, defined using international expert …

The Role Of Transoral Incisionless Fundoplication (Tif) In The Management Of Gastroesophageal Reflux Disease (Gerd) Following Peroral Endoscopic Myotomy (Poem): A Pilot, Prospective, Patient-Driven Study, Fares Ayoub, Tara Keihanian, Noor Zabad, Salmaan Jawaid, Kalpesh Patel, Mohamed O Othman

Faculty, Staff and Students Publications

BACKGROUND: Gastroesophageal reflux (GERD) is a concern after peroral endoscopic myotomy (POEM). Transoral incisionless fundoplication (TIF) has been recently described as a possible therapy for post-POEM GERD in case series.

METHODS: We prospectively enrolled patients undergoing POEM who agreed to participate in objective post-procedure GERD evaluation. Patients with objective evidence of GERD and suitable anatomy were offered TIF vs. proton pump inhibitor (PPI) only. Patients who underwent TIF were compared to those on PPI-only therapy after follow-up.

RESULTS: Of 21 enrolled POEM patients with objective testing, GERD was found in 11 (52%). Of those eligible for TIF, 4 (40%) opted …

Severe Febrile Neutropenia And Pancytopenia In A Patient With Advanced Hepatocellular Carcinoma Treated With Atezolizumab And Bevacizumab: A Case Report, Shadi Chamseddine, Michael Lapelusa, Kristen Carter, Van Nguyen, Yehia I Mohamed, Yara Sakr, Cristhiam M Rojas-Hernandez, Rikita I Hatia, Manal Hassan, John A Goss, Khaled M Elsayes, Asif Rashid, Ryan Sun, Hop Sanderson Tran Cao, Hesham M Amin, Ahmed O Kaseb

Faculty, Staff and Student Publications

BACKGROUND: Immune checkpoint inhibitors (ICIs), agents that stimulate T-cell function, have become the standard first-line treatment for unresectable hepatocellular carcinoma (HCC). However, they may also cause immune-related adverse events (irAEs), which are rare and have not been extensively reported. Here, we describe a case of severe febrile neutropenia and pancytopenia after atezolizumab plus bevacizumab (atezo/bev) therapy and its treatment course.

CASE DESCRIPTION: The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a …

Trends, Predictors, And Outcomes Of Hepatic Encephalopathy Treatment At A Quaternary Transplant Center From 2012-2022, Patrick Twohig, Thoetchai Peeraphatdit, Kaeli Samson, Makayla Schissel, Lynette M. Smith, Kyaw Min Tun, Ellen Tan, Kyle Scholten, Jason Barbaretta, Kevin Brittan, Timothy Mccashland

Graduate Medical Education Research Journal

Background: Hepatic encephalopathy (HE) is a devastating complication of cirrhosis that increases mortality. Many patients do not receive guideline recommended HE treatment.

Our aim is to evaluate trends in HE treatment over time, variables associated with receiving treatment, and outcomes based on the type of treatment received.

Methods: Retrospective single-center cohort study of hospitalized patients with HE from July 2012 – June 2022. HE treatment was defined as receiving lactulose, rifaximin, or combination therapy.

Results: A total of 1,683 unique patients were included, 72% of patients received HE treatment. Fewer HE patients received any treatment in 2022 (65.9%) compared to …

Association Between Helicobacter Pylori Infection, Mismatch Repair, Her2 And Tumor-Infiltrating Lymphocytes In Gastric Cancer, Carlos A Castaneda, Miluska Castillo, Luis A Bernabe, Joselyn Sanchez, Matteo Fassan, Katherine Tello, Ignacio Ivan Wistuba, Ivan Chavez Passiuri, Eloy Ruiz, Juvenal Sanchez, Fernando Barreda, Daniel Valdivia, Yaqueline Bazan, Milagros Abad-Licham, Claudio Mengoa, Hugo Fuentes, Paola Montenegro, Ebert Poquioma, Raul Alatrista, Claudio J Flores, Luis Taxa

Faculty, Staff and Student Publications

BACKGROUND: The influence of Helicobacter-pylori (H. pylori) infection and the characteristics of gastric cancer (GC) on tumor-infiltrating lymphocyte (TIL) levels has not been extensively studied. Analysis of infiltrating-immune-cell subtypes as well as survival is necessary to obtain comprehensive information.

AIM: To determine the rates of deficient mismatch-repair (dMMR), HER2-status and H. pylori infection and their association with TIL levels in GC.

METHODS: Samples from 503 resected GC tumors were included and TIL levels were evaluated following the international-TILs-working-group recommendations with assessment of the intratumoral (IT), stromal (ST) and invasive-border (IB) compartments. The density of CD3, CD8 and CD163 …

Anomalous Presentation And Endoscopic Findings Of Acute Esophageal Necrosis: A Case Report, Ahmed Shehadah, Abdullah A. Orakzai, Sheza Malik, Alshaima Yousef, Ali Jaan, Patrick Okolo

Advances in Clinical Medical Research and Healthcare Delivery

Introduction:

Acute esophageal necrosis (AEN), is a rare disorder with an estimated incidence of 0.01-0.28%. It typically affects the distal third of the esophagus. Approximately 90% of patients with acute esophageal necrosis present with upper gastrointestinal (GI) bleeding, primarily due to ischemic insult or severe hemodynamic compromise. In this report, we describe a case in which the patient presented with odynophagia and dysphagia, but without upper GI bleeding. The patient exhibited pan mucosal involvement of the esophagus, which extended to the gastric antrum.

Case: A 55-year-old man with a history of type 2 diabetes mellitus and substance abuse presented with …

Feasibility And Safety Of Peroral Endoscopic Myotomy With Fundoplication In Patients With Achalasia: A Systematic Review And Meta-Analysis, Faisal Kamal, Muhammad Ali Khan, Wade Lee-Smith, Sachit Sharma, Ashu Acharya, Umer Farooq, Zahid Ejaz, Muhammad Aziz, Manesh Kumar Gangwani, Umar Hayat, Anand Kumar, Alexander Schlachterman, David E. Loren, Thomas E. Kowalski

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Achalasia can cause disabling symptoms that may substantially impair the quality of life. Peroral endoscopic myotomy (POEM) has shown promising results in the management of achalasia. In this meta-analysis we have evaluated the feasibility and safety of single-session POEM with fundoplication (POEM+F) in patients with achalasia.

METHODS: We reviewed several databases from inception to July 08, 2022, to identify studies evaluating the feasibility and/or safety of single-session POEM+F for patients with achalasia. Our outcomes of interest included the technical success of POEM+F, adverse events, esophagitis and wrap integrity on follow-up upper endoscopy, total procedure time, and fundoplication time. Pooled …

Recurrent Upper Gastrointestinal Bleeding Due To Radiation-Induced Hemorrhagic Gastroduodenal Ectasia: A Review Of Current Treatment Options For Radiation-Induced Gastric Injury, Simone Jarrett, Rushi Kaushik Talati, Johann Hasbun, Wenqing Cao, Scott Smukalla

Einstein Health Papers

INTRODUCTION: Acute upper gastrointestinal bleeding is one of the most common medical emergencies that present to the hospital, and delineating the underlying etiology is essential to provide adequate definitive treatment. The purpose of this case report was to review the diagnosis and treatment of a rare complication known as radiation-induced hemorrhagic gastritis (RIHG) that can occur in patients with prior radiation exposure. The motivation for this study arose from the identification of a case within our institution.

CASE PRESENTATION: The study involved a review of the diagnosis and management of a patient who presented with anemia and recurrent episodes of …

A “Fishy” Situation, Rare Pathogen And Presentation In Prosthetic Valve Infective Endocarditis, Nichole Schtupak, Patrick Kennedy, Darko Pucar, Linda Godinez, Jodi-Ann Chin, Kristen Selema, Dipan Uppa, Antonio Lewis, Marcelo Helguera

DMSc Student Publications

Lactococcus garviae (L. garviae) is a gram-positive coccus belonging to the Streptococcaceae family. While primarily a pathogen in fish farms causing hemorrhagic sepsis, it can act as a rare opportunistic pathogen in humans. A 2021 case report by Bravo et al. documented less than 30 cases of infective endocarditis caused by L. garviae worldwide at that time. This case report describes the 27th documented case globally and 7th documented case in the USA of L. garviae causing infective endocarditis of a prosthetic valve.
L. garviae is found in unpasteurized dairy products, raw fish, and meat (pork, beef, and …

Predicting Mortality Within 1 Year Of Art Initiation In Children And Adolescents Living With Hiv In Sub-Saharan Africa: A Retrospective Observational Cohort Study, Alexander Kay, Bhekumusa Lukhele, Sandile Dlamini, Abigail Seeger, Phumzile Dlamini, Sandile Ndabezitha, Nobuhle Mthethwa, Teresa Steffy, Lilian Komba, Pauline Amuge, Eunice Ketangenyi, Peter Elyanu, Adamson Munthali, Amos Msekandiana, Yvonne Maldonado, Elizabeth Chiao, Adeodata Kekitiinwa, Lineo Thahane, Lumumba Mwita, H Lester Kirchner, Anna Maria Mandalakas

Faculty, Staff and Students Publications

BACKGROUND: Differentiated service delivery (DSD) for children and adolescents living with HIV can improve targeted resource use. We derived a mortality prediction score to guide clinical decision making for children and adolescents living with HIV.

METHODS: Data for this retrospective observational cohort study were evaluated for all children and adolescents living with HIV and initiating antiretroviral therapy (ART); aged 0-19 years; and enrolled at Baylor clinics in Eswatini, Malawi, Lesotho, Tanzania, and Uganda between 2005 and 2020. Data for clinical prediction, including anthropometric values, physical examination, ART, WHO stage, and laboratory tests were captured at ART initiation. Backward stepwise variable …

Red Raspberries Attenuate Blood Glucose Spike Of A High Glycemic Load Breakfast Cereal, Dante J. Martin

Master's Theses

Blood glucose (BG) spikes increase chronic disease risk in those with and without diabetes. The fiber and phytonutrient content of fruit, such as raspberries has the potential to attenuate the BG spike of a high glycemic load (HGL) meal. We examined the effect of red raspberries (RRs) on the BG spike when added to a HGL meal. In this randomized cross-over trial, 16 university students were given breakfast cereal and almond milk (control), the control breakfast with 140g added RRs, and the control breakfast with sugar equivalent to the sugar content of the RRs (50% sugar increase from control). Meals …

Design And Evaluation Of Scancap: A Low-Cost, Reusable Tethered Capsule Endoscope With Blue-Green Illumination Imaging For Unsedated Screening And Early Detection Of Barrett's Esophagus, Cheima Hicheri, Ahad M Azimuddin, Alex Kortum, Joseph Bailey, Yubo Tang, Richard A Schwarz, Daniel Rosen, Shilpa Jain, Nabil M Mansour, Shawn Groth, Shaleen Vasavada, Ashwin Rao, Adrianna Maliga, Leslie Gallego, Jennifer Carns, Sharmila Anandasabapathy, Rebecca Richards-Kortum

Faculty, Staff and Students Publications

Esophageal carcinoma is the sixth-leading cause of cancer death worldwide. A precursor to esophageal adenocarcinoma (EAC) is Barrett's Esophagus (BE). Early-stage diagnosis and treatment of esophageal neoplasia (Barrett's with high-grade dysplasia/intramucosal cancer) increase the five-year survival rate from 10% to 98%. BE is a global challenge; however, current endoscopes for early BE detection are costly and require extensive infrastructure for patient examination and sedation. We describe the design and evaluation of the first prototype of ScanCap, a high-resolution optical endoscopy system with a reusable, low-cost tethered capsule, designed to provide high-definition, blue-green illumination imaging for the early detection of BE …

Infection-Related Readmissions Are Rising Among Patients With Hepatorenal Syndrome: A Nationwide Analysis, Umer Farooq, Zahid I. Tarar, Ammad J. Chaudhary, Abdallah E. Alayli, Faisal Kamal, Chengdu Niu, Kamran Qureshi

Division of Gastroenterology and Hepatology Faculty Papers

Hepatorenal syndrome (HRS) is a unique form of renal dysfunction that results from circulatory hemodynamic dysfunction in advanced liver disease. We aimed to determine longitu- dinal trends in both all-cause and cause-specific readmissions for HRS in the United States. Using the National Readmission Database (2010–2018), we identified adult HRS patients during index admission via ICD codes. Fisher’s exact test and Cox regression analysis were used to compare pro- portions and compute adjusted p-values, respectively. Regression models were adjusted for gender, age, the Charlson comorbidity index, median household income, and hospital factors. A total of 169,522 HRS patients were included in …

Management Of Variceal Hemorrhage From Extensive Portal Vein Tumor Thrombus In Hepatocellular Carcinoma And Untreated Pheochromocytoma: A Case Report, Patrick Twohig, Kishan Patel, Tomoki Sempokuya, Chijoke Enweluzo, Lyudmila Muinov, Ishfaq Bhat

Graduate Medical Education Research Journal

Background: Over 600,000 people in the United States (U.S.) have liver cirrhosis. It is estimated that 30% of patients with compensated cirrhosis and 60% of patients with decompensated cirrhosis will develop varices in their lifetime, with an incidence rate of new varices at 9% per year. Fifty percent of patients with esophageal varices will experience bleeding at some time. Pheochromocytoma is a rare catecholamine secreting adrenal gland tumor that occurs in 2-8 people per every 1 million people in the general population. Standard treatment for variceal bleeding includes endoscopic band ligation and/or radiologic embolization along with non-selective beta blockers. However, …

Outcomes Of Endoscopic Submucosal Dissection In Cirrhotic Patients: First American Cohort, Robert Luke Pecha, Fares Ayoub, Ankur Patel, Abdullah Muftah, Michael W Wright, Mai A Khalaf, Mohamed O Othman

Faculty, Staff and Students Publications

BACKGROUND: Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions, surgical intervention carries a much higher bleeding risk. When such lesions are discovered, endoscopic submucosal dissection (ESD) may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection.

AIM: To evaluate the outcomes of ESD in patients with cirrhosis.

METHODS: Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location, size, and anticoagulation use. Procedural outcomes were compared between groups.

RESULTS: A total of 64 Lesions from 59 patients …

Pain Management In Perforated Appendicitis: Transitioning To A Minimal Narcotic Strategy, Seth Saylors, Meredith Elman, Pablo Aguayo, Rebecca M. Rentea, Richard J. Hendrickson, David Juang, Charles L. Snyder, Jason D. Fraser, Tolulope A. Oyetunji Md Mph, Shawn D. St Peter, Nelimar Cruz-Centeno, Charles Marchese

Research Days

Introduction: Patient controlled analgesia (PCA) was previously standard for postoperative pain control in children with perforated appendicitis at our institution. We previously reported the equivocal outcome of intravenous (IV) acetaminophen as a pain control adjunct used to transition from PCA to oral narcotics. We have since transitioned to a PCA-free, multi-modal pain control regimen postoperatively in perforated appendicitis. Through observational study, we aim to describe the impact of our new pain control regimen on postoperative narcotic use.

Methods: Children– June 2020 at a single freestanding children’s hospital were reviewed. Details of their hospitalization, including demographic, operative, anesthesia, pain management, and …