Diseases Commons^™

Model For End-Stage Liver Disease-Sodium Underestimates 90-Day Mortality Risk In Patients With Acute-On-Chronic Liver Failure, Ruben Hernaez, Yan Liu, Jennifer R Kramer, Abbas Rana, Hashem B El-Serag, Fasiha Kanwal

Faculty, Staff and Students Publications

BACKGROUND & AIMS: It is unclear whether the model for end-stage liver disease-sodium (MELD-Na) score captures the clinical severity of acute-on-chronic liver failure (ACLF). We compared observed 90-day mortality in patients with ACLF with expected mortality based on the calculated MELD-Na and examined the consequences of underestimating clinical severity.

METHODS: We identified patients with ACLF during hospitalization for cirrhosis in 127 VA hospitals between 01/01/2004 and 12/31/2014. We examined MELD-Na scores by ACLF presence and grade. We used actual and observed 90-day mortality to estimate a standardized mortality ratio (SMR) by ACLF presence and grade. We used transplant center-specific median …

The Cancer Patient And Cardiology, José Luis Zamorano, Christer Gottfridsson, Riccardo Asteggiano, Dan Atar, Lina Badimon, Jeroen J Bax, Daniela Cardinale, Antonella Cardone, Elizabeth A M Feijen, Péter Ferdinandy, Teresa López-Fernández, Chris P Gale, John H Maduro, Javid Moslehi, Torbjørn Omland, Juan Carlos Plana Gomez, Jessica Scott, Thomas M Suter, Giorgio Minotti

Faculty, Staff and Students Publications

Advances in cancer treatments have improved clinical outcomes, leading to an increasing population of cancer survivors. However, this success is associated with high rates of short- and long-term cardiovascular (CV) toxicities. The number and variety of cancer drugs and CV toxicity types make long-term care a complex undertaking. This requires a multidisciplinary approach that includes expertise in oncology, cardiology and other related specialties, and has led to the development of the cardio-oncology subspecialty. This paper aims to provide an overview of the main adverse events, risk assessment and risk mitigation strategies, early diagnosis, medical and complementary strategies for prevention and …

Multivessel Traumatic Coronary Artery Dissection After A Motor Vehicle Accident With Successful Percutaneous Coronary Intervention, Yagya Pandey, Brittany Owen, Gilad Birnbaum, Rashed Tabbaa, Ihab Hamzeh, Nasser Lakkis, Waleed Kayani

Faculty, Staff and Students Publications

Coronary artery dissection is a rare complication of blunt chest wall trauma. We report a case of acute left anterior descending and right coronary artery dissections after a motor vehicle accident. The musculoskeletal injuries obscured the cardiac symptoms. Electrocardiogram and bedside echocardiogram revealed cardiac pathology, which prompted urgent coronary angiography and intervention. (Level of Difficulty: Advanced.)

External Stoma Diversion: A Palliative Measure For Peristomal Wound Healing In Resource-Limited Settings, Rachel W Davis, Youmna A Sherif, Catherine Anne Morrison

Faculty, Staff and Students Publications

The provision of intestinal stoma care is challenging in austere settings due to limitations in surgical and wound care access as well as the high cost and sparsity of ostomy supplies. As a result, many surgical patients suffer from ostomy-related complications such as peristomal wounds and are unable to find relief for these complications from standard treatments and measures. This article describes the external stoma diversion, a cost-effective palliative surgical procedure that assists in the healing of peristomal wounds in resource-limited settings.

Cutaneous Manifestations Of Covid-19: Case Report And Discussion, Abigail Russell, Gary Gross, Vashist Nobbee

HCA Healthcare Journal of Medicine

Introduction: Various cutaneous manifestations of COVID-19 have been described and awareness of these findings is beneficial for clinicians for an accurate diagnosis.

Clinical Findings: We present a case of skin findings consistent with acral microthrombi induced changes in an elderly gentleman who was positive for COVID-19.

Outcomes: The patient had a mild course of COVID-19. Cutaneous findings resolved after one week from presentation with supportive care.

Conclusions: This case highlights the importance of awareness of manifestations of COVID-19, which may assist in timely diagnosis and prevention of transmission.

Covid-19 With Congruent Affect, Mitchell Thomas

HCA Healthcare Journal of Medicine

Music is a vehicle of capturing an individual’s experiences: a new beginning, a broken heart, complete joy, and even catharsis. Before deciding to embark on my path in medicine, music was my interest. Creating music is my therapeutic method of relieving stress, providing a productive outlet when coping with my stressors, and allowing me to focus on becoming a better student doctor. It has carried me through tough times and continues to do so. This instrumental song I wrote represents how I felt as a second-year medical student going through the COVID-19 pandemic; from being isolated in a state away …

Starting Residency With Covid-19, Seena Khosravi, Ashish Sinha

HCA Healthcare Journal of Medicine

Introduction

By Dr. Ashish Sinha, MD, PhD, DABA, MBA, FASA

As a Program Director of a just established anesthesia program, one faces enough challenges. A curve ball that I was not expecting was one of my residents to inform me on July 3rd that he was feeling feverish with chills, had myalgia and a headache. First response in my mind, that I didn’t verbalize was, ”Anosmia too?” I arranged COVID testing ASAP in a drive-by setting, which we could avail immediately. My resident had driven from New Orleans, LA to Riverside, CA, making a few stops along the way, (food, …

Covid Intensive Care Unit Through The Eyes Of Ophthalmologists, Laura Drayer Turner, Dharshana Ramanathan, Sneha Melmane, Geeta Menon

HCA Healthcare Journal of Medicine

The disproportionate impact of COVID on the mortality and morbidity of people of black, Asian and minority ethnic (BAME) backgrounds has been recognised and is under investigation. Here we present a different impact: that on the psyche. As three doctors of BAME heritage, we shared an experience of being redeployed from ophthalmology to the COVID Intensive Care Unit. We share our reflections on the experience and lessons learned.

Informing Strategy To Ensure Detection: Perceptions Of Coronavirus Testing In A Southeastern U.S. Urban Homeless Population, Colleen Bell, Theodore Bosi, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction: Attitudes of those in the homeless population toward testing, particularly during a pandemic, are critical to understand, so that they and their communities may be safely triaged and protected. Homeless persons are more likely to be exposed during viral epidemics, and have greater vulnerability for more severe viral illness, due to greater medical comorbidities. The literature reflects a dearth of published papers describing the perceptions, interest, and motivations of homeless people to seek or receive viral testing, despite their status as a high-risk population.

Methods: A quality improvement project consisting of a cross-sectional survey took place at 8 SARS-CoV-2 …

The Impact Of Covid-19 On Admission Rates For Individuals With Substance Use Disorders, Devin J. Mcdonald, Linda Zhang, William Brady Dehart

HCA Healthcare Journal of Medicine

Background: Limited data exist regarding the prevalence of substance use disorders or utilization of mental health care during the COVID-19 pandemic. Our study aims to specifically identify trends in the utilization of behavioral health units (BHU) in those with substance use disorders (SUD).

Methods: Patient electronic health records (EHR) were analyzed from fourteen hospitals principally located in the US mid-Atlantic region. To compare SUD admissions before and after COVID-19 quarantine time periods, patient data from BHUs were collected from two time-periods: February 1st, 2019 to May 31st, 2019, and February 1st, 2020 to May 31st, 2020.

Results: The number of …

The Effect Of Hydroxychloroquine On In-Hospital Mortality In Covid-19, Samar Aboulenain, Nakeya Dewaswala, Fergie Ramos, Pedro Torres, Ahmed Abdallah, Mohamed Abdul Qader, Baher Al-Abbasi, Charles R. Bornmann, Karolina N. Dziadkowiec, Kai Chen, Jesus E. Pino, Robert Chait, Kleper De Almeida

HCA Healthcare Journal of Medicine

Background: Hydroxychloroquine (HCQ) is an antimalarial medication that has been tested against various viral illnesses. The available evidence regarding the role of HCQ in the coronavirus disease 2019 (COVID-19) remains controversial.

Methods: This is a comparative retrospective cohort study that aims to evaluate the efficacy and safety of HCQ in hospitalized patients with COVID-19. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included ICU admission rate, mechanical ventilation, prolonged length of stay (LOS), QTc prolongation and cardiac arrest.

Results: A cohort of 175 hospitalized patients with COVID-19 were included with a median (interquartile range [IQR]) age of 66 [48–79] …

Innovative Conservation Of Inhaled Medication Devices During The Covid-19 Pandemic Through A Canister Reassignment Process, Mandelin K. Cooper, L. Hayley Burgess, Karla Miller, Theresa Baltz, Julia Moody, Elizabeth Wiggins, Jeffrey Guy

HCA Healthcare Journal of Medicine

Background: The ideal practice for patients requiring metered-dose inhalers (MDI) with coronavirus disease 2019 (COVID-19) is to use patient specific MDIs. However, this practice may not be possible during a time of increased usage throughout the country and limited availability of the medication. Nebulized medications are a concern due to the potential for aerosolized virus and increased exposure for health care workers. An alternative program of canister reassignment is proposed to address concerns for infection prevention, cross-contamination of MDI canisters and the shortage of MDI’s due to the COVID-19 pandemic.

Methods: A comprehensive MDI canister reassignment process was developed for …

Sars-Cov-2 Antibody Positivity And Prevalence In An Outpatient Medical Setting In Las Vegas, Nv, Sassan Kaveh, Kimball Kaufman, Tina Danai, Hossein Akhondi

HCA Healthcare Journal of Medicine

Background: SARS-CoV-2 antibody testing shows the prevalence of COVID-19 disease in different communities and has epidemiological significance.

Methods: SARS-CoV-2 IgM and IgG were tested in 319 patients, staff and visitors of a primary care clinic in Las Vegas, NV on a continuous as-requested basis.

Results: Prevalence of SARS-CoV-2 antibodies was 3.76% in a primary care office in Las Vegas, NV. Positivity of IgM was 0.31% and IgG 3.44%. The most common symptoms reported amongst those who tested positive were cough, shortness of breath and loss of smell and taste. The most common comorbidities included hypertension, chronic lung disease, seasonal allergies, …

Universal Testing Of Covid-19 Infection On A New Orleans, La Labor And Delivery Unit, Vidda Moussavi, Tiffany C. Chang, Alison M. Key, Minmin Luo, Alice S. Tong, Chi Dola

HCA Healthcare Journal of Medicine

Background: The greater New Orleans area emerged as an early epicenter of the COVID-19 pandemic, with one of the highest infection and death rates per capita in the United States. The first case of COVID-19 in an obstetric patient at Tulane Lakeside Hospital occurred on March 22, 2020. Given increasing concern for asymptomatic carriers, the labor and delivery unit implemented universal testing of all patients and their support partners starting on April 1, 2020.

Methods: A retrospective chart review of all obstetric encounters was performed to determine the incidence of COVID-19, characterize the natural history of COVID-19 and evaluate obstetric …

Covid-19 Needs Assessment And Support For Primary Care Practices In Western North Carolina, Sheri Denslow, Jill Fromewick, Kacey Scott, Jesse Bossingham, Brian Cass, Bryan Hodge, Erica L. Richman, Tammy Garrity, Kathleen Mottus, Jacqueline R. Halladay

HCA Healthcare Journal of Medicine

Background: It is critical to ensure that Primary Care Providers (PCPs) have adequate personal protective equipment (PPE), supplies, training, staffing, and contingency planning during pandemics, particularly in rural areas. In March 2020, during the onset of the COVID-19 pandemic, the Mountain Area Health Education Center (MAHEC), in collaboration with the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, rapidly created and conducted a needs assessment of PCPs in western North Carolina (WNC).

Methods: A group of twenty volunteers conducted a telephone survey of PCPs in a 16 county region of WNC. Practices were asked about their …

Remdesivir-Warfarin Interaction: A Case Report, Kayihura Manigaba, Josh Hawks, Marie Kima

HCA Healthcare Journal of Medicine

A greater than 65-year-old Caucasian woman receiving long-term anticoagulation with warfarin for atrial fibrillation experienced a sudden rise in an international normalized ratio (INR) after she was started on remdesivir for management of 2019 Novel Coronavirus (COVID-19). Patient INR was maintained within the target therapeutic range of 2–3 with a warfarin dose of 11 mg/week before starting remdesivir. After 2 days of remdesivir therapy, the patient’s INR increased significantly and remained elevated during the 5 day course of remdesivir therapy. Patient required an interruption of her warfarin therapy for 7 days, and her INR did not return to the targeted …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Respiratory Distress With Minimal Exertion: A Case Of 2019 Novel Coronavirus (Covid-19) Pneumonia, Nicholas Fusco, Latha Ganti, Amanda L. Webb, Jessica Houck, Bryan Kwon, David Lebowitz

HCA Healthcare Journal of Medicine

COVID-19 is a new coronavirus that can cause severe respiratory distress. Interestingly, patients can present with COVID-19 and appear relatively well but with significant hypoxia, even with minimal movement. The authors present the case of a well-appearing gentleman who became acutely short of breath while undergoing chest imaging, stating he could not breathe. He tested positive for COVID-19 and recovered. His presentation, clinical course and imaging findings are discussed.

Pulmonary Embolism And Giant Cavitary Lesion Developing After Covid-19 Pneumonia, Ahmet Vural, Ahmet Nedim Kahraman

HCA Healthcare Journal of Medicine

Introduction: The clinical manifestations of the worldwide pandemic, which began in mainland China in December 2019, were very similar to viral pneumonia and defined as Coronavirus disease 2019 (COVID-19). Complications such as acute respiratory distress syndrome (ARDS), acute cardiac tissue damage, secondary infections, isolated coagulopathy and pulmonary embolism have been reported with COVID-19 disease.

Clinical Findings: A 79-year-old woman admitted to the emergency room (ER) had complaints of fever and cough. The patient was admitted to the ER with the suspicion of COVID-19. Samples were collected with a nasopharyngeal swab and confirmed as COVID-19. In addition, a chest CT examination …

Extracorporeal Membrane Oxygenation For Covid-19 Treatment In A Community Hospital, Daniel I. Loube, Kashif Z. Hassan, Sang H. Lee

HCA Healthcare Journal of Medicine

Coronavirus disease 2019 (COVID-19) may result in severe acute respiratory disease syndrome (ARDS) and death. For COVID-19 patients failing mechanical ventilation, extra corporeal membrane oxygenation (ECMO) has been used with varying efficacy in academic medical centers and quaternary referral centers. We report the successful use of veno-venous (VV) ECMO to treat refractory ARDS due to COVID-19 in a community hospital setting with a survival to discharge rate of 71% over a 3 month period. In a community hospital with adequate resources, VV ECMO can be an effective rescue therapy for selected COVID-19 patients who fail all other available treatments.

Covid-19 And Arrhythmias: A Review Of Cardiac Electrophysiology Associated With Sars-Cov-2, Kashmala Khan, Francis Dimtri, Carlos Vargas, Thomas Alexander

HCA Healthcare Journal of Medicine

Coronavirus infectious disease 2019 (COVID-19) has become one of the most recognized viral illnesses to date. Most people infected with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have a benign clinical course, but there have also been catastrophic outcomes. Although, notoriously known to affect the respiratory system, extra-pulmonary manifestations have also been established. An increasing number of people have been reported to present with cardiac manifestations, which include but are not limited to arrhythmias. The cardiac conduction system can be damaged by various mechanisms in patients infected with SARS-CoV-2. In this review, we will attempt to briefly describe the arrhythmogenic …

After A Horrid Year, Free Streaming Of ‘Dancing At The Vatican' Is An Inspirational Gift And A Call To Aid Huntington's Disease Families, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.

The Public Health Demand For Revoking Non-Medical Exemptions To Compulsory Vaccination Statutes, Emma Tomsick

Journal of Law and Health

In 2019, the United States saw the single largest outbreak of measles in recent history. The measles crisis has prompted state legislative bodies to face a seemingly impossible dilemma: eliminate both religious and philosophical exemptions to mandatory school vaccination statutes or sit by idly and allow measles to continue to run its course. As of June 2019, five states have neither religious nor philosophical exemptions to their mandatory vaccination statutes. This Note argues that states should remove all religious and philosophical exemptions to compulsory vaccination statutes. The 2019 measles outbreak demonstrates that the anti-vaccination movement poses a legitimate risk to …

Global Burden Of Acute Lower Respiratory Infection Associated With Human Metapneumovirus In Children Under 5 Years In 2018: A Systematic Review And Modelling Study, Xin Wang, You Li, Maria Deloria-Knoll, Shabir A. Madhi, Cheryl Cohen, Syed Asad Ali, Sudha Basne, Quique Bassat, W Abdullah Brooks, Malinee Chittaganpitch

Department of Paediatrics and Child Health

Background: Human metapneumovirus is a common virus associated with acute lower respiratory infections (ALRIs) in children. No global burden estimates are available for ALRIs associated with human metapneumovirus in children, and no licensed vaccines or drugs exist for human metapneumovirus infections. We aimed to estimate the age-stratified human metapneumovirus-associated ALRI global incidence, hospital admissions, and mortality burden in children younger than 5 years.
Methods: We estimated the global burden of human metapneumovirus-associated ALRIs in children younger than 5 years from a systematic review of 119 studies published between Jan 1, 2001, and Dec 31, 2019, and a further 40 high …

Differences In Gynecologic Tumor Development In Amhr2-Cre Mice With Krasg12d Or Krasg12v Mutations, Eucharist H S Kun, Yvonne T M Tsang, Sophia Lin, Sophia Pan, Tejas Medapalli, Anais Malpica, Joanne S Richards, David M Gershenson, Kwong-Kwok Wong

Faculty, Staff and Students Publications

How different KRAS variants impact tumor initiation and progression in vivo has not been thoroughly examined. We hypothesize that the ability of either KRASG12D or KRASG12V mutations to initiate tumor formation is context dependent. Amhr2-Cre mice express Cre recombinase in tissues that develop into the fallopian tubes, uterus, and ovaries. We used these mice to conditionally express either the KRASG12V/+ or KRASG12D/+ mutation. Mice with the genotype Amhr2-Cre Pten(fl/fl) KrasG12D/+(G12D mice) had abnormal follicle structures and developed low-grade serous ovarian carcinomas with 100% penetrance within 18 weeks. In contrast, mice with …

Coronavirus Update 11/24/20, The Coronavirus Planning Team

University Briefings & Virtual Events

One final message before the Thanksgiving weekend break to wrap up a few things.

Diagnosing And Managing Post-Stroke Aphasia, Shannon M. Sheppard, Rajani Sebastian

Communication Sciences and Disorders Faculty Articles and Research

Introduction: Aphasia is a debilitating language disorder and even mild forms of aphasia can negatively affect functional outcomes, mood, quality of life, social participation, and the ability to return to work. Language deficits after post-stroke aphasia are heterogeneous.

Areas covered: The first part of this manuscript reviews the traditional syndrome-based classification approach as well as recent advances in aphasia classification that incorporate automatic speech recognition for aphasia classification. The second part of this manuscript reviews the behavioral approaches to aphasia treatment and recent advances such as noninvasive brain stimulation techniques and pharmacotherapy options to augment the effectiveness of …

Lifetime Risk Of Diabetes In Metropolitan Cities In India, Shammi Luhar, Dimple Kondal, Rebecca Jones, Ranjit M. Anjana, Shivani A. Patel, Sanjay Kinra, Lynda Clarke, Mohammed K. Ali, Dorairaj Prabhakaran, Muhammad Masood Kadir

Community Health Sciences

Aims/hypothesis: We aimed to estimate the lifetime risk of diabetes and diabetes-free life expectancy in metropolitan cities in India among the population aged 20 years or more, and their variation by sex, age and BMI.
Methods: A Markov simulation model was adopted to estimate age-, sex- and BMI-specific lifetime risk of developing diabetes and diabetes-free life expectancy. The main data inputs used were as follows: age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by …

Covid-19: Best Practices And The Way Forward, Juliana Nwauwa

Student Scholarly Projects

COVID-19 is a global health emergency that originated in Wuhan, China, in December 2019. It was declared a pandemic on March 11, 2020, and since then has affected more than 53,507,282 individuals and claimed the lives of more than 1,305,164 around the globe. It is a respiratory virus transmitted from person to person through airborne aerosols and droplets from infected individuals and direct contact with infected surfaces.

Numerous factors, such as socioeconomic status, population density, pre-existing health conditions, and lack of health insurance, have contributed to the disproportionate impact of COVID-19 among certain demographic groups. The COVID-19 impact ranges from …

Happy Thanksgiving! And Hail To The Pharmaceutical And Biotech Industries – And The Scientists!, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.