Medical Specialties Commons^™

Outbreak Of Ebola Virus Disease, Alexandra Dimit, Tiffany Kneuss, Joelle Farano, Haley Armstrong, Jodi Otte, Andrew M. Roecker

Pharmacy and Wellness Review

Ebola virus disease (EVD) has existed as a major health concern with devastating and, many times, fatal symptoms. The recent outbreaks of EVD in West Africa and the Democratic Republic of the Congo (DRC) have incited international concern. In this article, the implications of EVD will be discussed including the etiology, transmission, signs and symptoms, diagnosis and treatment of the disease. In addition to this discussion, the manner in which major health care organizations, including the World Health Organization (WHO), are dealing with treating infected patients and containing spread of the disease will be covered.

Recent Advances Spark Significant Guideline Change: Antiretroviral Therapy (Art) At High Cd4+ Counts In The Treatment Naïve Patient, Joshua Ilenin, Kelly Fargo, Lisa Berni, Kristen Thatcher, Caitlin Swann, Andrew Roecker

Pharmacy and Wellness Review

Human immunodeficiency virus (HIV) targets CD4+ lymphocytes, a critical component to proper functioning of the human immune system. HIV is a significant public health concern, having resulted in over 27 million deaths since its discovery. Currently, several different treatment options exist, with combination antiretroviral therapy (ART) at the forefront. Despite the success of ART therapy, there are number of problems, including poor patient compliance. Due to this, the appropriate time to initiate therapy in the treatment naïve patient is under continuous scrutiny. Recently, several trials have demonstrated evidence suggesting that initiating ART at high CD4+ counts in the treatment naïve …

Creutzfeldt Jakob Disease: Progressive Neurological Decline, Christine Fayad Md, Scott J. Anderson, H. Alex Akhondi Md

Internal Medicine

No abstract provided.

Genome-Wide Variation In Potyviruses, Deepti Nigam, Katherine Latourrette, Pedro F.N. Souza, Hernan Garcia Ruiz

Nebraska Center for Virology: Faculty Publications

Potyviruses (family Potyviridae, genus Potyvirus) are the result of an initial radiation event that occurred 6,600 years ago. The genus currently consists of 167 species that infect monocots or dicots, including domesticated and wild plants. Potyviruses are transmitted in a non-persistent way by more than 200 species of aphids. As indicated by their wide host range, worldwide distribution, and diversity of their vectors, potyviruses have an outstanding capacity to adapt to new hosts and environments. However, factors that confer adaptability are poorly understood. Viral RNA-dependent RNA polymerases introduce nucleotide substitutions that generate genetic diversity. We hypothesized that selection imposed by …

Macrophage-Associated Wound Healing Contributes To African Green Monkey Siv Pathogenesis Control, Fredrik Barrenas, Kevin Raehtz, Cuiling Xu, Lynn Law, Richard R. Green, Guido Silvestri, Steven E. Bosinger, Andrew Nishida, Qingsheng Li, Wuxun Lu, Jianshui Zhang, Matthew J. Thomas, Jean Chang, Elise Smith, Jeffrey M. Weiss, Reem A. Dawoud, George H. Richter, Anita Trichel, Dongzhu Ma, Xinxia Peng, Jan Komorowski, Cristian Apetrei, Ivona Pandrea, Michael Gale Jr.

Nebraska Center for Virology: Faculty Publications

Natural hosts of simian immunodeficiency virus (SIV) avoid AIDS despite lifelong infection. Here, we examined how this outcome is achieved by comparing a natural SIV host, African green monkey (AGM) to an AIDS susceptible species, rhesus macaque (RM). To asses gene expression profiles from acutely SIV infected AGMs and RMs, we developed a systems biology approach termed Conserved Gene Signature Analysis (CGSA), which compared RNA sequencing data from rectal AGM and RM tissues to various other species. We found that AGMs rapidly activate, and then maintain, evolutionarily conserved regenerative wound healing mechanisms in mucosal tissue. The wound healing protein fibronectin …

Nearly Complete Genome Sequences Of 17 Enterovirus D68 Strains From Kansas City, Missouri, 2018, Suman B. Pakala, Yi Tan, Ferdaus Hassan, Annie Mai, Robert H. Markowitz, Meghan H. Shilts, Seesandra V. Rajagopala, Rangaraj Selvarangan, Suman R. Das

Manuscripts, Articles, Book Chapters and Other Papers

Here, we report 17 nearly complete genome sequences of enterovirus D68 (EV-D68) isolated from Kansas City, MO, in 2018. Phylogenetic analysis suggests that these strains belong to subclade B3, similar to the ones that caused the 2016 epidemics in the United States but different from the 2014 outbreak B1 strains.

Estimation Of Infectious Intestinal Disease Burden And Description Of The Infectious Disease Surveillance System In Ras Al Khaimah, United Arab Emirates, Fatema Hamdan Saif Al Alkeem Al Zaabi

Dissertations

Introduction: Infectious disease (ID) is an ongoing problem worldwide. In order to manage this problem, it is important to have an integrated and effective surveillance system that can be used to estimate the burden of ID. There is a scarcity of studies published on the prevalence of IDs in the United Arab Emirates (UAE), both in hospital settings and in the community. Infectious Intestinal Disease (IIDs) have been one of the most commonest IDs that have been studied in the community around the world, there are no studies on the prevalence of IIDs in Ras Al Khaimah (RAK). Furthermore, while …

Plasma Cysteine/Cystine And Glutathione/Glutathione Disulfide Redox Potentials In Hiv And Copd Patients., Walter H. Watson, Jeffrey D. Ritzenthaler, Paula Peyrani, Timothy L. Wiemken, Stephen P. Furmanek, Andrea Reyes-Vega, Tom J. Burke, Yuxuan Zheng, Julio A. Ramirez, Jesse Roman

Faculty and Staff Scholarship

Chronic obstructive pulmonary disease (COPD) is prevalent in patients infected with HIV. The purpose of this study was to test the hypothesis that systemic oxidation correlates with loss of lung function in subjects with COPD, and that HIV infection can contribute to creating such an environment. Subjects were recruited at the University of Louisville in the following groups: HIV-infected (n = 36), COPD (n = 32), HIV and COPD (n = 28), and uninfected controls with normal lung function (n = 34). HIV infection was assessed by viral load and CD4 cell counts. Pulmonary function was determined by spirometry …

Oral Fungal Microbiota: To Thrush And Beyond, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

The oral microbiota is complex, multikingdom, interactive, and involves extensive biofilm formation. While dominated by bacteria, Candida is a frequent member of this microbiota; however, several other potentially pathogenic fungi (among around 100 identified species) appear to reside in some individuals, including Cryptococcus, Aspergillus, and Fusarium. Oral candidiasis may manifest as a variety of disease entities in normal hosts and in the immunocompromised. These include pseudomembranous candidiasis (thrush), hyperplastic or atrophic (denture) candidiasis, linear gingival erythema, median rhomboid glossitis, and angular cheilitis. The purpose of this review is to describe the oral fungal microbiota (ie, oral mycobiota), …

Cavitary Lesion In An Immunocompromised Adult, Syed Talha Qasmi, Turuvekere Jayaram, Enrique Rincon

Internal Medicine

No abstract provided.

Contraceptive Use Following Unintended Pregnancy Among Ugandan Women Living With Hiv, Jana Jarolimova, Jerome Kabakyenga, Kara Bennett, Winnie R. Muyindike, Annet Kembabazi, Jeffrey N. Martin, Peter W. Hunt, Yap Boum, Jessica E. Haberer, David Bangsberg, Angela Kaida, Lynn T. Matthews

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda.

Study design: This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or …

Sterile Compounding: Regulations Addressed After The Meningitis Outbreak Of 2012, Kelly M. Dye, Tara M. Tokar, Halle M. Orlinski, Heather Helsel, Marcia M. Worley

Pharmacy and Wellness Review

No abstract provided.

Antibiotic Stewardship And Overcoming Antibiotic Resistance In Upper Respiratory Tract Infections, Katherine Elsass, Austin Hilverding, Steve Blake, Brendan Rasor, Steven N. Leonard

Pharmacy and Wellness Review

Antibiotic resistance has rapidly become one of the most significant challenges facing modern health care. Despite widespread public education efforts by the national government and health organizations worldwide, there remains a significant lack of public understanding of antibiotic resistance, how to prevent it and the implications if the science and health care communities fail to find a solution. The Centers for Disease Control and Prevention (CDC) and the American College of Physicians (ACP) recently published updated guidelines for appropriate antibiotic use in upper respiratory tract infections. These guidelines include several key recommendations for acute bronchitis, pharyngitis and acute rhinosinusitis (including …

Legionnaires' Disease, A Rising Occurrence In The United States, Jennifer Harklerode, Olivia Henton, Myranda Smith, Rebecca Worden, Andrew Roecker

Pharmacy and Wellness Review

Legionella pneumophila, a microscopic bacterium usually responsible for a number of illnesses and fatalities, can eliminate a local population, a region or even a nation. In 1976, L. pneumophila was first discovered due to a number of cases presenting with pneumonia-like symptoms. These cases occurred in an isolated population attending an American Legion convention in Philadelphia, Pennsylvania, therefore lending to the name Legionella. Usually found in aquatic environments such as lakes, streams, cooling towers, air conditioning systems and hot tubs, its ability to thrive in artificial and natural environments makes it an ideal bacterium. L. pneumophila can be transmitted via …

Zika Virus Induced Neurological Disorders And Impacts On Public Health, Alexandra Herman, Martha Zimmerman, Olivia Vanscoy, Olivia Henton, Lindsey Peters

Pharmacy and Wellness Review

Zika virus is a public health emergency of international concern. Zika virus (ZIKV) is a mosquito-borne pathogen that is carried by the Aedes genus. Zika is spread through direct bite and nonvector transmission. Most individuals infected with Zika will be asymptomatic, but some may present nonspecific viral symptoms. A rising number of neurological disorders in newborns whose mothers were infected with ZIKV during pregnancy have been reported due to recent outbreaks. Neurological disorders affect both the central and peripheral nervous systems and can result from bacterial, viral, fungal or parasitic infections of the nervous system or from the immune response …

Zika Virus: Infectious Process And Public Health Response, Morgan Homan, Julia Dickman, Jenna Deininger, Austin Hopkins, Olivia Henton, Steven N. Leonard

Pharmacy and Wellness Review

The Zika virus has become a growing concern as a global pandemic. Since being identified in Uganda in 1947, the virus has spread around the world, recently emerging in South America with a great impact on Brazil. As of 2016, Zika has made its appearance in the United States and is now actively being transmitted in Florida. The virus is a mosquito-vectored flavivirus primarily transmitted by the Aedes mosquito which infects a human through biting. Transmission through sexual intercourse is also possible as well as transmission from a pregnant woman to her fetus. This latter form of transmission presents the …

Aap To Honor Dr. Jackson With Lifetime Achievement Award, Children's Mercy Hospital

Our Story Continues

Mary Anne Jackson, MD, FAAP, FPIDS, FIDSA, is a rarity among physicians. Her curriculum vitae reads like a virtual “Who’s Who” in pediatric infectious diseases. She’s served as an associate editor of the American Academy of Pediatrics’ Red Book, a musthave reference for pediatricians across the nation.

Plus, she’s recently added the title of Interim Dean, University of Missouri-Kansas City School of Medicine, to her long list of accomplishments. She is also a Professor of Pediatrics and Pediatric Infectious Diseases specialist at Children’s Mercy Kansas City.

The AAP Section on Infectious Diseases will present Dr. Mary Anne Jackson with a …

Dose Effects Of Recombinant Adenovirus Immunization In Rodents, Eric A. Weaver

Nebraska Center for Virology: Faculty Publications

Recombinant adenovirus type 5 (rAd) has been used as a vaccine platform against many infectious diseases and has been shown to be an effective vaccine vector. The dose of the vaccine varies significantly from study to study, making it very diffcult to compare immune responses and vaccine effcacy. This study determined the immune correlates induced by serial dilutions of rAd vaccines delivered intramuscularly (IM) and intranasally (IN) to mice and rats. When immunized IM, mice had substantially higher antibody responses at the higher vaccine doses, whereas, the IN immunized mice showed a lower response to the higher rAd vaccine doses. …

Combating Antibiotic Resistance In The 21st Century, Kevin Krivanek, Brian Heilbronner, Brendan Rasor, Kelsey Lindsley, Andrew Roecker

Pharmacy and Wellness Review

Antibiotic resistance is one of the most significant challenges facing the medical community today. In response, the Centers for Disease Control and Prevention (CDC) created a list of the greatest antibiotic resistance threats, a number of which are gram-positive bacteria. The cell wall of these organisms has long been a favored target of antibiotic therapies, but the development of numerous resistance mechanisms has led to widespread resistance against nearly all major antibiotic compounds on the market. The medical community is faced with the task of developing better antibiotic compounds that preclude the spread of bacterial resistance and also increasing the …

Advances In Treatment Of Chronic Hepatitis C Virus (Hcv) Infection, Halle Orlinski, Kimberly Loughlin, Haley Armstrong, Emily Blum, Andrew M. Roecker

Pharmacy and Wellness Review

Hepatitis C virus (HCV) infection is a prominent cause of chronic liver disease and may lead to serious complications such as liver failure and need for a transplant. The virus is transmitted via exposure to blood and is classified into various genotypes based on genetic mutations in the virus. Current treatment options for HCV infection are not effective in all patients, and there are limited options for patients infected with a genotype other than genotype 1. Two new medications have been approved recently for treatment of HCV infection. Simeprevir (Olysio®) gained U.S. Food and Drug Administration (FDA) approval in November …

Whooping Cough: A Pharmacist's Role In An Emerging Endemic, Haley Armstrong, Lydia Suchecki, Sarah Lipperman, Taylor Roberson, Andrew M. Roecker

Pharmacy and Wellness Review

Pertussis is an acute infectious disease caused by the organism Bordetella pertussis and characterized by a "whooping cough." Incidence of the disease had declined since the development of a vaccine, but is now increasing in reported cases. This increase has been attributed to both an increased awareness but also surmised to be related to a decrease in vaccinations. The pertussis vaccine is given in conjunction with tetanus and diphtheria vaccines to children before the age of 6 in five separate injections over the course of four to six years. A booster is now recommended for the older child and adults …

Fda Approves New Tuberculosis Drug: Bedaquiline (Sirturo®), Megan Ruffner, Kent Wilin, Charles Hay, Zachary Crawford, Andrew Roecker

Pharmacy and Wellness Review

Tuberculosis (TB), caused by the acid-fast bacilli (AFB) Mycobacterium tuberculosis, is an infectious disease that continues to greatly impact morbidity and mortality worldwide; in 2011 it caused 1.4 million deaths. Some strains of the bacteria have become resistant to current treatment regimens, resulting in multidrug-resistant (MOR) and extensively drugresistant (XOR) TB. The emergence of these resistant strains of bacteria calls for new treatment regimens that can quickly and effectively eradicate the organism. The U.S. Food and Drug Administration (FDA) recently approved Sirturo® (bedaquiline) with the indication of MDR pulmonary TB. Bedaquiline introduces a novel mechanism of action via the inhibition …

Truvada® Recommended By Fda Committee For Pre-Exposure Prophylaxis In High-Risk Hiv-Negative Individuals, Justin Steele, Emily Blum, Alison Steinbrunner, Lara Long, Andrew M. Roecker

Pharmacy and Wellness Review

Once-daily combination tenofofovir disoproxil fumarate (TDF) and emtricitabine (FTC) has received Food and Drug Administration (FDA) approval for use in pre-exposure prophylaxis (PrEP) against Human Immunodeficiency Virus (HIV) infection in high-risk individuals. In clinical trials, FTC/TDF has been shown to reduce the risk of HIV acquisition by 62 percent in sexually active heterosexual men and women. Similarly, use of FTC/TDF demonstrated a 44 percent reduction in HIV infection within the men who have sex with men population.⁷ When used compliantly and in conjunction with safe sex practices, it appears that FTC/TDF can play an important role in reducing the …

Nanoparticles In The Treatment Of Chronic Lung Diseases, Teodora G. Alexescu, Simina Tarmure, Vasile Negrean, Maria Cosnarovici, Victoria M. Ruta, Ionela Popovici, Ioana Para, Mirela G. Perne, Olga H. Orasan, Doina A. Todea

Journal of Mind and Medical Sciences

Nanoparticles, although considered a topic of modern medicine, actually have an interesting history. Currently, advances in nanomedicine hold great promise as drug carrier systems for sustained release and targeted delivery of diverse therapeutic agents. Nanoparticles can be defined as complex drug carrier systems which incorporate and protect a certain drug or particle. Nanoparticles can be administered via different routes, such as intravenous injection, oral administration, or pulmonary inhalation. Even though the use of nano-carriers via pulmonary inhalation is heavily debated, this system represents an attractive alternative to the intravenous or oral routes, due to the unique anatomical and physiological features …

The Evaluation Of Liver Fibrosis Regression In Chronic Hepatitis C Patients After The Treatment With Direct-Acting Antiviral Agents – A Review Of The Literature, Olga H. Orasan, George Ciulei, Sorina C. Coste, Bianca A. Cibu, Adela V. S Taut, Simina F. Tarmure, Iulia O. Pfingstgraf, Teodora G. Alexescu, Ionela E. Popovici, Flaviu Mureșan, Fabian Ovidiu, Vasile Negrean, Angela Cozma

Journal of Mind and Medical Sciences

The second-generation of direct-acting antiviral agents are the current treatment for chronic viral hepatitis C infection. To evaluate the regression of liver fibrosis in patients receiving this therapy, liver biopsy remains the most accurate method, but the invasiveness of this procedure is its major drawback. Different non-invasive tests have been used to study changes in the stage of liver fibrosis in patients with chronic viral hepatitis treated with the second-generation of direct-acting antiviral agents: liver stiffness measurements (with transient elastography or acoustic radiation force impulse elastography) or different scores that use serum markers to calculate a fibrosis score. We prepared …

Nocardia Beijingensis: A Rare And Unusual Cause Of Intracranial Abscess, Lakshpaul Chauhan Md, Nirali Vassa Md, Elizabeth Henderson Md, Ateeq Mubarik Md, Danish M. Siddiq Md, Abdulmagid Eddib Md

Infectious Disease

Background : Nocardia species are thin, aerobic, filamentous, gram-positive bacilli that are ubiquitous in soil worldwide. Nocardia infections are divided into three main categories: pulmonary nocardiosis, disseminated nocardiosis, and cutaneous nocardiosis.

Methods : We present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB).

Results : A 60-year-old Caucasian lady from Florida with type 2 diabetes mellitus, hypertension, hyperlipidemia, presented to the emergency room with complaints of altered mentation. Per husband, she was having episodes of emesis and diarrhea three days prior to admission that resolved however, her mentation significantly deteriorated to where she was …

Changes In Body Mass Index And Atherosclerotic Disease Risk Score After Switching From Tenofovir Disoproxil Fumarate To Tenofovir Alafenamide., Jason J. Schafer, Kaitlin N. Sassa, Jaclyn R. O'Connor, Ayako Shimada, Scott W. Keith, Joseph A. Desimone

College of Pharmacy Faculty Papers

Background: Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF)-containing antiretroviral therapy (ART) can improve renal function and bone mineral density in people with human immunodeficiency virus (PWH). The switch can also negatively influence cholesterol, but changes in body mass index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk are unknown.

Methods: This retrospective observational study evaluated BMI and ASCVD risk score changes in virologically suppressed PWH who switched from TDF to TAF without switching other ART regimen components. Adults on TDF for ≥1 year with 2 consecutive HIV ribonucleic acid values/mL before a TAF switch were included. Body weight, …

Assessment And Improvement Of Data Collection Errors Through Inter-Departmental Collaboration, Charlott Williams, Kelli L. Behr, Mary Moffatt, Rangaraj Selvarangan

Posters

Specific Aims:

1. To maintain the ED team's high rate of accuracy in data collection
2. To begin team participation in corrective action planning
3. To improve interdepartmental problem solving

Conclusion

Open communication about errors among all collaborating departments, combing with a shared approach to solving them:

• improved morale and perception of error tracking by the team
• led to a decrease in errors overall, and
• increased interdepartmental collaboration

When all members of the interdepartmental team work together with a positive approach to corrective action, improvement in error rates is a natural outcome of the solutions derived.

The Essential Role Of Carbon Metabolism In The Virulence Of Cryptococcus Neoformans, Mara Weigner

Senior Honors Theses

Cryptococcus neoformans infections are a major cause of meningoencephalitis in immunosuppressed patients worldwide. Inhaled as spores or desiccated yeast cells, C. neoformans can undergo metabolic changes in response to the new host environment that allow it to cross the blood brain barrier and cause deadly central nervous system (CNS) infections. Nutrient acquisition, and specifically carbon metabolism, is critical for survival and proliferation within the host. Notably, efficient carbon metabolism is necessary to produce the polysaccharide capsule, which is arguably C. neoformans’ most important and well-studied virulence factor. As such, a better understanding of carbon acquisition and regulation is essential for …

Improving Pneumococcal Vaccination Rates In High Risk Patients Across Multiple Specialty Divisions, Rachel Moran, Julia G. Harris, Claire Olsen, Rana El Feghaly, Liset Olarte, Douglas Blowey, Luke A. Harris

Posters

Pediatric patients with deficient immune systems or certain chronic medical conditions have an increased risk of acquiring invasive pneumococcal disease.

The 23-valent pneumococcal (PPSV23) vaccine provides protection against 23 pneumococcal serotypes and is recommended for patients aged 2 years or older who are high-risk for invasive pneumococcal disease.

Unfortunately, many high-risk patients are not properly vaccinated due to lack of provider knowledge or understanding of accountability between primary care and specialty providers.

The goal of this project was to improve PPSV23 vaccination rates by 10-20% across multiple Children's Mercy Kansas City specialty divisions.