Medical Sciences Commons^™

Development Of Models For The Study Of The Molecular Mechanisms Of Host Restriction And Adaptation Of Hantaviruses., Ryan Carroll Mcallister 1988-

Electronic Theses and Dissertations

Hantaviruses, family Bunyaviridae, are present throughout the globe in a variety of mouse, rat, mole, vole, shrew, or bat species. Hantaviruses persist for the lifetime of the animal reservoir, while causing no signs or symptoms of disease. Only the rodent-borne hantaviruses cause disease in humans. In contrast, a “spillover” infection of a hantavirus into a nonreservoir rodent species results in an asymptomatic acute infection. We and others in the field are interested in understanding the biology of these virus-host interactions and mechanisms that underlie these three very different outcomes. The second chapter of my thesis focused on probing the intrahost …

An Integrated Transcriptome And Expressed Variant Analysis Of Sepsis Survival And Death., Ephraim L. Tsalik, Raymond J. Langley, Darrell L. Dinwiddie, Neil A. Miller, Byunggil Yoo, Jennifer C. Van Velkinburgh, Laurie D. Smith, Isabella Thiffault, Anja K. Jaehne, Ashlee M. Valente, Ricardo Henao, Xin Yuan, Seth W. Glickman, Brandon J. Rice, Micah T. Mcclain, Lawrence Carin, G Ralph Corey, Geoffrey S S. Ginsburg, Charles B. Cairns, Ronny M. Otero, Vance G. Fowler, Emanuel P. Rivers, Christopher W. Woods, Stephen F. Kingsmore

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Sepsis, a leading cause of morbidity and mortality, is not a homogeneous disease but rather a syndrome encompassing many heterogeneous pathophysiologies. Patient factors including genetics predispose to poor outcomes, though current clinical characterizations fail to identify those at greatest risk of progression and mortality.

METHODS: The Community Acquired Pneumonia and Sepsis Outcome Diagnostic study enrolled 1,152 subjects with suspected sepsis. We sequenced peripheral blood RNA of 129 representative subjects with systemic inflammatory response syndrome (SIRS) or sepsis (SIRS due to infection), including 78 sepsis survivors and 28 sepsis non-survivors who had previously undergone plasma proteomic and metabolomic profiling. Gene …

Analysis Of Differential Mrna And Mirna Expression In An Alzheimer’S Disease Mouse Model, Amanda Hazy, Matthew Dalton

Other Undergraduate Scholarship

Research has shown that changes in gene expression play a critical role in the development of Alzheimer’s Disease (AD). Our project will evaluate genome-wide RNA expression patterns from brain and blood in an AD mouse model. This analysis will provide insight regarding the mechanisms of AD pathology as well as determine a possible diagnostic tool utilizing RNA expression patterns found in the blood as biomarkers for AD.

Malignant Hyperthermia, Chase Contri

Nursing Student Class Projects (Formerly MSN)

Although very rare, occurring one out of every 100,000 anesthesia cases, malignant hyperthermia is a hypermetabolic disorder that anesthesia providers screen and interrogate patients prior to every case they are administering anesthesia. Many research studies about anesthesia induced malignant hyperthermia have explored new methods of testing for the genetic susceptibility for malignant hyperthermia and into hospital based protocols when a patient starts to show the signs and symptoms of the metabolic disorder. This new knowledge and understanding has decreased patient mortality of anesthesia induced malignant hyperthermia from eighty percent to five percent over the past three decades (Rosenberg et al, …

Malignant Hyperthermia, Devin Poncsak

Nursing Student Class Projects (Formerly MSN)

A crisis of malignant hyperthermia is a medical emergency, and must be treated immediately with a coordinated, multidisciplinary team response in order to give the patient the highest chance for a successful recovery (Dirksen, Van Wicklin, Mashman, Neiderer, & Merritt, 2013). Malignant hyperthermia is defined by Bandschapp & Girard (2012), as “a disturbance of the skeletal muscle calcium homeostasis, triggered by volatile anaesthetics and depolarizing muscle relaxants.” Once a vulnerable patient is exposed to one of these triggering agents, a pathologic hypermetabolic response ensues, and the patient has a rapid increase in oxygen consumption and expired carbon dioxide, hyperthermia, acidosis, …

Acute Respiratory Distress Syndrome, Brian Flowers

Nursing Student Class Projects (Formerly MSN)

In healthcare, there are many interesting and intriguing conditions that are vital to understand from both a clinical and a pathophysiological standpoint. Comprehending and knowing how to treat these conditions effectively, ultimately leads to the best care and patient outcomes. As a current critical care nurse and future advanced practice nurse, it was important to select a research topic of interest to explore that would benefit a high risk group of patients. Based on this precedent, acute respiratory distress syndrome (ARDS) was chosen. As a critical care nurse, exposure to respiratory conditions and mechanical ventilation management is something nurses are …

Management Of A Dka Patient With Severe Metabolic And Ketoacidosis With Chronic Renal Insufficiency, Brian Albany

Nursing Student Class Projects (Formerly MSN)

Diabetic ketoacidosis (DKA) serves as one the leading causes of mortality in diabetic patients [14]. The mortality has decreased over the past several decades due to the rapid recognition of the disease state and the improvement of management of DKA [14]. Despite a decline in mortality rates over the past twenty years from 7.96% to 0.67%, errors in management of the disease state are associated with significant morbidity and mortality [2]. Utilization of DKA protocols in the acute care setting have allowed congruency in care and delivery of effective lifesaving treatment. Despite advances in standardized DKA protocols, there still remains …

Craniocervical Arterial Dissection, Joseph Weisenberger

Nursing Student Class Projects (Formerly MSN)

The annual incidence for spontaneous carotid artery dissection (CAD) ranges from 2 to 3/100,000 patients and is even lower for a spontaneous vertebral artery dissection (VAD). Furthermore, there is only a .08% - .04% chance for the incidence of a traumatic dissection (TD), of the entire trauma population (Mortazvi, Verma, Tubbs, Harrigan, 2011). However, despite these low levels, CAD/VADs pose a serious threat to a patient’s plan of care if not identified and treated early.

The Pathophysiology Of Tumor Lysis Syndrome In Oncology Patients, Jessica Richardson

Nursing Student Class Projects (Formerly MSN)

Patients with oncological conditions are at an increased risk of developing a wide variety of complications from chemotherapy that they would not otherwise be exposed too. One such life threatening complication is tumor lysis syndrome, which is an oncology emergency that frequently lands patients in the intensive care unit. Tumor lysis syndrome (TLS) occurs most frequently after the initiation of chemotherapy or other chemotoxic drugs during the patients’ treatment course [8]. It causes faster than normal tumor cell breakdown and release of intracellular contents into the general circulation. [8]. This leads to a very predictable development of electrolyte imbalances to …

Multimodal Therapy For Postoperative Pain Management, Karen Lynch

Nursing Student Class Projects (Formerly MSN)

Multimodal therapy works best to control postoperative pain safely. Multimodal pain treatment involves the use of two or more classes of analgesics to target different pain mechanisms. Why? Data is present that supports that health care systems are still under treating pain in the postoperative patient. Unrelieved pain has harmful effects to multi ple body systems. There is still a need to provide education to providers, nurses and patients to promote best practice in pain management approaches regarding multimodal therapy. Opiate analgesics still remain the most commonly used treatment for pain following surgery. Using this singular analgesic modality could put …

Necrotizing Fasciitis, Holly Herron

Nursing Student Class Projects (Formerly MSN)

Necrotizing fasciitis also known as necrotizing soft tissue infections (NSTIs) is a rare life-threatening infection that involves the skin and soft tissue. A rapid and accurate diagnosis of NSTIs must be identified by healthcare providers to diminish morbidity and mortality. NSTIs are characterized by progressive necrosis of subcutaneous tissue and fascia involving large areas of tissue (Lin, Chang, Lai, Lin, & Chen, 2013). Hippocrates (500 BC) described necrotizing fasciitis as “diffuse erysipelas caused by trivial accidents [where] flesh, sinews, and bones fell away in large quantities, [leading to] death in many cases” (Lancerotto, Tocco, Salmaso, Vindigni & Bassetto, 2012). In …

Necrotizing Fasciitis: The “Flesh Eating” Disease, John Neukam

Nursing Student Class Projects (Formerly MSN)

Necrotizing fasciitis, often referred to as the “flesh-eating disease”, is a rare bacterial infection with an extremely high mortality rate with symptoms that begin subtle but can quickly ravish the human body.1 While the prevalence of this disease is relatively low, evidence of this disease can be traced back as far as the 5th century BC where it was initially described by Hippocrates.2 It wasn’t until 1952 however that Dr. Bob Wilson termed the disease “necrotizing fasciitis”.3 The rapid progression of this disease and the acute deterioration it causes in a patient is extremely intriguing. This “flesh-eating disease” can present …

Accurate Intervention In Visceral Aneurysms, Megan Hoying

Nursing Student Class Projects (Formerly MSN)

A 30 year old male presented to the ED with a one week history of fever, abdominal pain, and poor PO intake due to nausea and emesis. He was given a GI cocktail and sent home for a presumed diagnosis of gastritis. After having persistent pain the patient returned to the ER the following day and was admitted for further testing. The patient died 3 days later. This is an interesting case presentation, and was in no way straightforward.

When Exercise Is A Pain In The Head, Rebecca D. Granger

Nursing Student Class Projects (Formerly MSN)

Headache is one of the five most common chief complaints in the US, resulting in nearly 5 million visits to the ED (Lange, 2011). With great variance in quality, etiology, pathophysiology, and as a potential indicator of a serious underlying problem, it is critical that these headaches be accurately diagnosed, primarily for rapid identification of life threatening factors, but also to offer treatment and education specific to the particular type of headache the patient is experiencing. This will result in better outcomes for the patient through better control and will subsequently save health care dollars by reducing ED visits and …

Pseudocholinesterase Deficiency, Ross Gerken

Nursing Student Class Projects (Formerly MSN)

Pseudocholinesterase deficiency is a rare genetic or acquired variation in the metabolism of choline esters such as the neuromuscular blockers succinylcholine, mivacurium, and ester local anesthetics. Pseudocholinesterase deficiency genetically is transmitted in an autosomal recessive pattern with the frequency of apnea from a genetic abnormality of pseudocholinesterase between 1:480 and 1:3200 people (Ok et al., 2013). An extended period of neuromuscular blockade results from these medications than what is clinically expected. The signs and symptoms which occur are apnea and paralysis hours longer. This condition is rare but must be known and understood by the clinician in order to provide …

Understanding The Mystery Of Brain Death, Natalie A. Felter

Nursing Student Class Projects (Formerly MSN)

Lack of understanding of brain death has contributed to recent controversial cases (Copnell, 2014). The cases of Jahi McMath and Marlise Munoz were the focus of national news, causing an intense debate among the public and healthcare professionals (Copnell, 2014). The concept of brain death is a mystery to the public (Powell, 2014). Copnell (2014) found that 60% of family members who had been told their loved one was brain dead believed that they were still alive. Health professionals not having a clear grasp of brain death’s definition and assessment can lead to increased confusion in family members (Powell, 2014).

Hypertrophic Obstructive Cardiomyopathy, Tiffany Branson

Nursing Student Class Projects (Formerly MSN)

Hypertrophic obstructive cardiomyopathy or HOCM, is a genetic disease that is described as hypertrophy or enlargement of the left ventricle which obstructs the blood flow to the body (Yue-Cheng et al., 2012). HOCM is a disease that cannot be cure, but can be treated. One of the main goals of treatment is to focus on treating the symptoms. HOCM can be asymptomatic or symptomatic and can cause some major complications. Some of the complications of HOCM are arrhythmias and sudden cardiac death, “which is defined as natural death to due cardiac causes, heralded by abrupt loss of consciousness within one …

Dvt And Economy Class Syndrome, Troy Perkins

Nursing Student Class Projects (Formerly MSN)

Traveling long distances can be very stressful on the body. Deep vein thrombosis (DVT) has often been linked to long air flights or long distance travel in a vehicle. DVT is a blood clot usually formed in the legs. Economy Class Syndrome (ECS) has been referred to as the formation of a DVT occurring during (or just after) a long airplane flight, especially in economy class where there is the least space allotted per passenger and one’s legs especially tend to be immobilized for lack of leg room (MedicineNet, 2012). Developing a DVT can lead to other life-threatening illnesses such …

Does Your Child Have Reflux Or Could There Be More To It Than That, Cody Elam

Nursing Student Class Projects (Formerly MSN)

Eosinophilic esophagitis (EE) is differentiated from Gastroesophageal Reflux Disease (GERD) by endoscopic and histopathologic examination. The hallmark of EE is eosinophilic infiltration of the esophagus. EE has been defined as “a clinicopathologic entity, combining clinical data on (1) relevant symptoms (distinct in the pediatric or adult populations with mostly food impaction and dysphagia in adults and feeding intolerance, failure to thrive, and GERD symptoms in children); (2) esophageal biopsies with adequate histologic findings in the esophageal biopsies (>15 eosinophils/high power field [HPF]); and (3) exclusion of other diseases with overlapping features, especially GERD” (Genevay, Rubbia-Brandt, & Rougemont, 2010, p.816). …

Protein Losing Enteropathy Following Fontan Palliation In The Single Ventricle Population, Alaina Dunkleberger

Nursing Student Class Projects (Formerly MSN)

Congenital heart defects requiring single ventricle palliation are a rare but life-threatening occurrence. There are multiple defects resulting in single ventricle physiology including defects in which the right or left ventricle within the heart is either undeveloped (hypoplastic left heart syndrome, hypoplastic right heart syndrome), or the valve to the main pulmonary artery did not form (pulmonary atresia). These defects prevent the heart from supplying adequate blood flow to the lungs or body. Single ventricle congenital heart defects are not easily treated surgically due to their complexity in nature. Single ventricle surgical palliation typically involves three open-heart surgeries including the …

Therapeutic Hypothermia Following Cardiac Arrest, Cassandra Patrick

Nursing Student Class Projects (Formerly MSN)

According to the Sudden Cardiac Arrest Foundation (2014), each year, 424,000 people in the U.S. (more than 1,000/day) experience EMS-assessed out-of-hospital non-traumatic sudden cardiac arrest. This is roughly equivalent to the number of people who die from Alzheimers’ disease, assault with firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer and suicides combined (Sudden Cardiac Arrest Foundation, 2014). It is estimated that the likelihood of surviving an out-of-hospital cardiac arrest (OHCA) to hospital discharge can be as low as 6% to 8% (Williams, Calder, Cocchi & Donnino, 2013). Additionally an estimated 200,000 hospitalized …

Effects Of Edmr On Veterans With Ptsd, Beth Abele

Nursing Student Class Projects (Formerly MSN)

Of all the mental health disorders, the most commonly diagnosed among Iraqi and Afghanistan wars is Posttraumatic stress disorder (PTSD) (Hellmuth et al., 2012). Veterans who are suffering the effects of PTSD are treated every day in VA Medical Centers across the country, as well as in private sector hospitals. Many of these men and women are battling with drug addictions and alcohol abuse in attempts to self medicate (Murdoch et al., 2010). According to nationally represented study by Murdoch and colleagues (2010), one fifth of individuals who have been diagnosed with PTSD use drugs, alcohol or both to treat …

Brain Death Determination, Bethani Knipfer

Nursing Student Class Projects (Formerly MSN)

Patient MR was a seventeen year old female involved in a motor vehicle collision which resulted in a traumatic brain injury leading to declaration of brain death. The pathophysiology behind the traumatic brain injury, the concept and use of a brain tissue monitoring device, and the tests used in the declaration of brain death will be explored. When brain death is determined, the patient has the opportunity to become an organ donor. Thousands of people are waiting for organs to become available. This is a huge healthcare concern that may be decreased if the general public is more educated regarding …

Lymphedema: Pathophysiology, Diagnosis & Management, Bernadine Cruz

Nursing Student Class Projects (Formerly MSN)

Lymphedema is a disfiguring condition whose hallmark is progressive, increasing swelling which occurs as a result of the accumulation of protein rich fluid in interstitial spaces. Those individuals who are affected suffer from either primary lymphedema or secondary lymphedema; the pathophysiology of both conditions is similar. Lymphedema can be a chronic, acute, or transient alteration, which can eventually lead to keratinization of the skin. An increase in the incidence of lymphedema has also been observed with increase in levels of obesity.

Angiotensin Converting Enzyme Related Angioedema, Andrea Sims

Nursing Student Class Projects (Formerly MSN)

A 54 year old female patient arrives to the emergency department (ED) via squad complaining that 2 days ago her lips were tingling and her face felt a little swollen but it subsided. Today she woke up with her tongue protruding out of her mouth, her lips, face and eyes are swollen. She does not present with itching or urticaria. Squad personnel established an IV, gave her intravenous (IV) Benadryl 50 mg, and 0.3 mg subcutaneous epinephrine without any change in her condition. The emergency medical service (EMS) also applied oxygen at 2 liters per minute (lpm). She denies taking …

Early Onset Alzheimer’S Disease In Individuals With Down Syndrome: Explored Theories Of Pathophysiology, Amanda Pack

Nursing Student Class Projects (Formerly MSN)

This presentation is a focus on some of the theories of the pathophysiology of early-onset Alzheimer’s Disease (AD) in individuals with Down Syndrome (DS). Down Syndrome, a genetic condition where an individual has a partial or full extra chromosome 21, is the most common chromosomal condition in the United States (National Down Syndrome Society (NDSS), 2012). Average life expectancy for individuals with DS has vastly increased in the last thirty years from age 25 to age 60 (NDSS, 2012). The extra chromosome genetically makes individuals with DS predisposed to certain conditions, including early onset dementia and AD, therefore as their …

The Mystery Of Transverse Myelitis: Can It Happen To You?, Jessica Castle

Nursing Student Class Projects (Formerly MSN)

Imagine a day like any other, as a healthy performs daily tasks without any particular difficulty. Then, the first fall happens. After standing and recovering, two more falls occur; however, despite all physical effort, standing proves to be a complete impossibility. Imagine the fear. What is going on? This unexplainable scenario happened to an 81 woman diagnosed with idiopathic transverse myelitis (TM) in May 2011, leaving her permanently paralyzed below the mysteriously appearing T9 lesion. This woman had only a personal history of asthma and breast cancer, and nothing significant in her family history. After 60 days of lumbar punctures, …

Acute Respiratory Distress Syndrome, Jaqueline Yunker

Nursing Student Class Projects (Formerly MSN)

Acute Respiratory Distress Syndrome is an inflammatory response resulting from injury to the alveolar-­‐capillary membrane. This injury is caused by a systemic inflammatory response that involves either direct trauma to the lung cells, such as a pneumonia, or indirect, such as sepsis. The inflammatory response that is triggered results in leaky alveolar-­‐capillary beds and infiltration of the lungs (Villar, 2011). This is very common with approximately 150,000 cases annually in the United States and a very high mortality rate of 60,000 deaths per year (Pipeling & Fan, 2010). Despite the high mortality rate, 15-­‐35%, there is no set of guidelines …

Licorice Consumption Causing Hypokalemia And Lethal Dysrhythmias, Gina Grosscup

Nursing Student Class Projects (Formerly MSN)

This report describes a case in which approximately a two-month exposure of licorice root tea consumption containing glycyrrhizic acid (GA) produced generalized weakness, secondary hypertension, hyporeflexia and hypokalemia, leading to a reentry dysrhythmia of ventricular fibrillation. Although licorice root has been used for medicinal purposes dating back centuries the potential toxic side effects can be life threatening without early recognition. Most licorice candies in the western world contain artificial flavoring but the use of actual licorice root containing GA is common in many Middle-Eastern, Far Eastern and European countries. The purpose of this report is two-fold, first to describe the …

Basics Of Oncologic Type B Lactic Acidosis: Increased Awareness For Better Outcomes?, Erin E. Steiner

Nursing Student Class Projects (Formerly MSN)

The most common and best known form of lactic acidosis, Type A, presents in the environment of tissue hypoxia. The lesser known form, Type B, does not involve tissue hypoxia, is not well understood, and very often results in death. No randomized controlled trials (RCTs) comparing treatment modalities currently exist (Ruiz, Singh, & Hart, 2011). Increased recognition by medical and nursing disciplines may result in quicker diagnosis, opportunity to implement treatment, possibility for RCTs, and better outcomes.