Medical Specialties Commons^™

What’S That Beeping Sound? Case Report, Ellie Balakhanlou Md, Olivier Rolin Md, Eugenio Monasterio

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Abstract Title: What’s that Beeping Sound? A Case Report

Ellie Balakhanlou, Medical Doctor - Medical Resident, Virginia Commonwealth University School of Medicine (Role: Presenting Author)

Olivier Rolin, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author)

Eugenio Monasterio, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author)

Disclosure: None. Setting: Outpatient pediatric clinic Patient: A 21 year old female with spastic quadriplegic cerebral palsy (CP) with an intrathecal baclofen (ITB) pump

Case Description:

The patient presented with concerns of intermittent beeping sounds from her pump. She does not endorse any …

Depression Is Associated With Weight Gain In Patients Transplanted For Nash Cirrhosis But Not Other Etiologies Of Cirrhosis, Jose Hernandez-Roman, Steven Shen, Samarth Patel, Mohammad Bilal Siddiqui, Anchalia Chandrakumaran, Masoud Faridnia, Emily Zhang, Emily Lee, Mohammad Shadab Siddiqui

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

The present study was to bridge this gap in knowledge by evaluating the relationship between depression, liver disease and weight change after LT. Weight gain after liver transplantation (LT) is common, particularly in patients transplanted for NASH cirrhosis, and is associated with reduced survival. In non-LT patients, presence and sub-optimal management of depression is closely associated with weight gain and obesity. The impact of depression as predictor of post-LT weight gain is currently not known. Method:All adult patients receiving LT between 7/2007 to 7/2017 were included in the analysis. Patients with graft failure or death within 6 months after …

Chronic Post-Surgical Abdominal Pain Treated With Percutaneous Peripheral Nerve Stimulation Of Iliohypogastric And Ilioinguinal Nerves, Harnek Bajaj, Denise Lester

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Chronic pelvic and lower abdominal pain can be a severely debilitating condition that affects between 7% to 24% of the general population (4). The anterior rami of L1 and T12 give contributions to the ilioinguinal and iliohypogastric nerves which provide sensory innervation to the lower abdomen and pubic regions (3). Entrapment or damage of these nerves can occur due to a variety of mechanisms, and common treatment options have included medications (2), nerve blocks (1), and in rare cases, surgical resection of the involved nerve. In this case, a 47 year old morbidly obese female with history of chronic left …

Improving Early Antibiotic Administration For Treatment Of Sepsis At Children’S Hospital Of Richmond At Vcu: 2012-2019, Hannah Miller Md, Ashlie Tseng Md, Perry Taylor Pharmd, Matthew Schefft Do Msha, Sheila Pedigo Pharmd Bcpps, Tracy Lowerre Bsn Ms, Jose Munoz Md, Mark Astoria Md, Jonathan Silverman Md Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: The Surviving Sepsis Campaign recommends initiating IV antibiotic administration within one hour of recognition of severe sepsis. Several studies have shown that prompt blood culture collection, administration of broad-spectrum antibiotics, and fluid resuscitation following recognition improves child survival.

Objective: Our goal was to evaluate effectiveness of sepsis initiatives and institutional changes in the timing of early antibiotic administration at Children’s Hospital of Richmond at VCU.

Methods: We formed a Pediatric Sepsis Committee with representatives from each unit in 2013. In 2016, the committee began tracking time from the order of a first stat dose IV antibiotic to administration as …

Prevalence Of The Hypervirulent Nap1/Bi/027 Strain Of C. Difficile In Southwestern Virginia And Risk Factors Associated With Infection, Andrew O. Hanna, Anthony Baffoe-Bonnie, Shikha Vasudeva

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

C. difficile infection (CDI) incidence has increased over the last several decades. The BI/NAP1/027 ribotype was discovered in 2005 and has since been responsible for multiple outbreaks in the US and Canada. This subtype of C. Difficile is known to be more virulent in vivo and produce more severe disease. Limited regional data of the prevalence of this ribotype is available, which could help guide treatment. Using infection control data from a large regional hospital and a VA medical center, this study documented the prevalence of the 027 ribotype in Southwest Virginia. Patients were included if they were tested at …

Getting On The Same Page: A Quality Improvement Project To Reduce Overnight Nursing-To-Resident Physician Pages In An Inpatient Rehabilitation Unit, Renae Fisher Md, Rajbir Chaggar Md, Anthony Zenger Md, Susan Hamilton Rn, Bsn, William Carter Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction
Many Physical Medicine and Rehabilitation (PM&R) residency programs utilize “home call” systems for nighttime coverage of inpatient services. In this system, trainees are expected to work at full capacity the following day after taking nocturnal call. While “on call,” trainees receive both urgent and non-urgent pages throughout the night, which disrupt sleep. To mitigate fatigue, improve hand-offs and improve timing of patient care, this study targeted reducing non-urgent overnight pages from nurses to home call PM&R residents between 11pm to 6am.

Methods

We implemented a prospective quality improvement study with interventions including holding “Getting on the Same Page” meetings …

Selecting The Optimal Unrelated Hematopoietic Stem Cell Transplant Donor For Relapse Prevention In Acute Myeloid Leukemia, Elizabeth Krieger, Rehan Qayyum, Amir Toor

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction/Background

Hematopoietic cell transplantation (HCT) provides

a cure for patients with acute myeloid leukemia.

Natural killer cells (NK) play an important role

in graft versus leukemia (GVL) effect after HCT,

through killer immunoglobulin-like receptor (KIR)

interaction with HLA ligands. This study is

undertaken to validate our previously published

mathematical model accounting for the KIR-KIRL

interactions in a post HCT setting.

Methods

Retrospective data were obtained from the Center

for International Blood and Marrow Transplant

Registry for 2317 donor recipient pairs (DRP) who

underwent 7/8 or 8/8 HLA allelic matched

unrelated donor (URD) HCT for AML. KIR-HLA

interaction scores were calculated …

Quiet A Puzzle: A Case Report Of 15 Year Old Female With Severe Anemia Due To Scurvy, Shaikha Alqahtani, Wang Zhihong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Scurvy is historically thought of a disease affecting sailors in the seventeenth century. Vitamin C deficiency is rare in the developed world. It is mainly found in patients with poor nutrition and specifically those with developmental delay. The spectrum of scurvy is varied and includes dermatological, dental, bone and systemic manifestations. We present to you a case of a 15 year old female with a history of trisomy 21 presenting with severe anemia as a direct cause of vitamin C deficiency.

She presented with a one month history of progressive bilateral lower extremity bruising and inability to walk. Physical exam …

Gastrointestinal Stromal Tumor (Gist) In Long Standing Crohn’S Disease On Anti-Tnf Therapy, David Mendel, Taseen Syed, H R. Lippman, Brian Davis

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Patients suffering from inflammatory bowel disease (IBD) are at increased risk for developing cancer. Adenocarcinomas are the most commonly observed tumors of the gastrointestinal tract whereas data on gastrointestinal stromal tumor (GIST) in IBD patients is limited. GIST is a neoplasm that originates from the interstitial cells of Cajal in the smooth muscle layers of the gastrointestinal tract. [1] The association between GIST and Crohn’s disease (CD) is debated, as the tumor inconsistently present in areas of inflammatory activity. We report an interesting case of CD maintained on Infliximab, who presented with a flare that revealed GIST in the …

Hip Labral Injury Worsens After Platelet Rich Plasma Injections: A Case Report, Brennan M. Wright, Carmen Wong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Case Description

A 47-year-old active male presented with 2.5 years of right hip pain suggestive of labral pathology. Ice, heat, celecoxib, ibuprofen, diclofenac gel, and physical therapy provided minimal relief. A diagnostic intra-articular bupivacaine injection resolved the pain. A subsequent MR arthrogram revealed a non-displaced tear of the right anterior superior acetabular labrum.

In pursuit of conservative treatment, the patient agreed to a series of 3 right hip intra-articular PRP (platelet rich plasma) injections. When he presented for the second injection, he reported his pain had decreased by 20% and he was tolerating light running. Due to improvement in symptoms, …

Reduced Length Of Stay In Major Hepatectomy Surgery After Implementation Of An Enhanced Recovery Pathway In The United States Veteran Population, Yvonne Nguyen Md, Marilyn Mcnulty Np, Leopoldo Fernandez Md, Michael R. Kazior Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery, however, evidence is lacking in major liver surgery, .This study aimed to evaluate the impact of an ERAS pathway in U.S. veterans undergoing major hepatectomy surgery. We hypothesized that the adoption of an ERAS pathway reduces decreased length of stay (LOS).

Methods

After approval from the Hunter Holmes McGuire VA Medical Center IRB, we compared data from consecutive patients undergoing elective open hepatectomy within an ERAS pathway (January 2019-December 2019) to a previous cohort of patients before introduction of ERAS (July 2016-December 2017). One surgeon performed all …

The Role Of Interleukin-18 In Myocardial Ischemia/Reperfusion, Yogesh Dhakal

Theses and Dissertations

Acute Myocardial Infarction (AMI) is one of the leading causes of morbidity for cardiovascular diseases (CVDs) in the western world. While mortality rates for AMI has reduced in the last 20 years due to advancements in clinical interventions, patients who have an AMI are significantly more likely to develop heart failure (HF) in the following years. Reperfusion of the ischemic tissue is a necessary procedure to restore blood delivery to cardiomyocytes, minimize myocardial dysfunction, and reduce infarct size. Still, the step of reperfusion itself induces myocardial damage in a phenomenon known as reperfusion injury. Considering that the degree of myocardial …

Process Factors Affecting Reperfusion Time In Patients Presenting With St-Segment Elevation Myocardial Infarction (Stemi), Richard R. Wall

Theses and Dissertations

Abstract PROCESS FACTORS AFFECTING REPERFUSION TIME IN PATIENTS

PRESENTING WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) By Richard R. Wall MSRS, RT(R)(CT)(CI), RCIS

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University.

Virginia Commonwealth University, 2020.

Dissertation Chair: Jeffrey S. Legg Ph.D. Associate Professor and Chair, Department of Radiation Sciences

An ST-segment myocardial infarction (STEMI) occurs when the blood flow to the myocardium is suddenly and completely blocked causing the myocardium to become ischemic. A STEMI is a life-threatening condition that necessitates emergent medical treatment. Research has shown that longer …

Role Of Nurd In Acute Leukemia Cell Survival, Javeria Aijaz

Theses and Dissertations

Depletion of the ATPase component of the Nucleosome Remodeling and Deacetylase (NuRD) complex, CHD4, reduces acute myeloid leukemia (AML) cell survival. This study identified other NuRD components, as potential therapeutic targets for disrupting protein-protein interactions within NuRD. In addition to AML, we established that T-cell Acute Lymphoblastic Leukemia (T-ALL) cell lines responded similarly to CHD4 depletion.

Greater than 90% depletion of either MBD2 or MBD3 (the mutually exclusive two DNA binding NuRD paralogues) – was unremarkable, but complete depletion of MBD3 increased apoptosis and genotoxic sensitivity. Combined depletion of MBD-NuRD proteins augmented apoptosis observed with complete MBD3 depletion - indicating …

Characterizing Glycosaminoglycan And Glycosaminoglycan-Oligo Interactions With Cancer Stem Cells And Their Regulators, Rahaman Navaz Gangji

Theses and Dissertations

Tumor metastasis and recurrence account for more than 90% of cancer-associated deaths and are thought to occur due to a small subpopulation of neoplastic cells known as cancer stem cells (CSCs). Because CSCs are resistant to conventional chemotherapy, there is a critical need to develop CSC-targeting agents. Microenvironmental components, especially glycosaminoglycans (GAGs), play a key role in regulating CSC phenotype. GAGs such as heparan sulfate (HS) interact with hundreds of proteins and influence a variety of biological processes including tumor proliferation, angiogenesis, metastasis and stem cell biology.

Recently, the Desai and Patel laboratories have demonstrated that a hexasaccharide form of …

The Effects Of Autophagy And Senescence On Sensitivity To Cisplatin In Head And Neck Cancer, Zara H. Siddiqui

Theses and Dissertations

While current treatments in cancer, such as chemotherapy and radiation, can generally be effective in eliminating disease in patients, there also exists the possibility of recurrence of cancer cells over time. In patients diagnosed with locally advanced head and neck carcinoma, about 50-60% develop a loco-regional recurrence within two years, and 20-30% of patients develop metastatic disease at distant sites in the body [5]. On a cellular level, one mechanism for this survival may be that natural mechanisms such as autophagy and senescence play a role in allowing cells to survive after undergoing treatment. One standard of care chemotherapy for …

Development Of A Torque-Based Device For The Quantification Of Arm Rigidity In Patients With Parkinson’S Disease, Georgina O. Miller

Theses and Dissertations

Parkinsonian rigidity is caused by the inability of the muscles to relax and extend properly, due to reduced dopamine levels and often begins on one side of the body before spreading contralaterally. The current standard for determining joint rigidity in a clinical setting is a test completed by the clinician based on the feel of the relaxed wrist and elbow joints as they are passively flexed and extended and a series of ordinal rating scales, the Movement Disorder Society’s – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr Scale (H&Y), and Parkinson’s Disease Questionnaire-39 (PDQ-39). These methods are used …

New Persistent And Chronic Opioid Use In Cancer Survivors After Curative Intent Radiation, Elena V. Fernández

Theses and Dissertations

Background: Emerging evidence suggests that as more patients are surviving cancer, new persistent opioid use (no prior exposure to opioids before cancer therapy but requiring opioid prescriptions after curative intent treatment; NPOU) is of greater concern. In patients receiving curative intent radiation (definitive radiation therapy and as treatment for cure; CIR), the extent to which patients develop NPOU or continue opioid use (COU) following CIR is not known. Neither are factors associated with NPOU or COU, opioid doses, or time to discontinuation (TTD) of opioids in 5CS known. Objectives: Describe longitudinal trends opioid use in cancer survivors who received CIR, …

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …

Black Women And Body Image: Implications Of The Racialized Beauty Aesthetic, Rachel L. Boutte

Theses and Dissertations

Black women have the highest prevalence of overweight and obesity relative to any other demographic group in the United States, however current weight management interventions appear least effective for them. Although several hypotheses have been proposed to explain these outcomes, few studies have collected data to evaluate how well they fit the lived experiences of Black women. In particular, the potential roles of body image and body dissatisfaction in the development and maintenance of overweight and obesity in Black women are not well understood. Extant literature largely reports that Black women are inoculated from body dissatisfaction due to cultural factors, …

Investigation Of Molecular Mechanisms Of Liver Preservation Injury: A Complication Preceding Organ Transplantation, Ria C. Fyffe-Freil

Theses and Dissertations

Of the over 108,000 American awaiting a life-saving organ transplant today, over 12,000 (11%) of those need a new liver (OPTN, 2020). Last year, only 35% of patients on the waiting list for an organ were transplanted. Improving the quality of marginal organs by preventing or reversing preservation injury could vastly increase the number of transplants performed. Washout of circulating blood during liver procurement with cold University of Wisconsin solution flushes out any endogenous pro-survival signaling molecules. We investigated lysophospholipid (LPL) surface receptors (G-protein coupled receptors for lysophosphatidic acid (LPA) and sphingosine- 1-phosphate (S1P)) and their role in protecting hepatocytes …

A State-Level Study Of Opioid Use Disorder Treatment Access And Neonatal Abstinence Syndrome, Elizabeth R. Wolf, Sebastian T. Tong, Roy T. Sabo, Steven H. Woolf, Kassie Abbinanti, James Pecsok, Alex H. Krist

Pediatrics Publications

Background Adult opioid use and neonatal abstinence syndrome (NAS) are growing public health problems in the United States (U.S.). Our objective was to determine how opioid use disorder treatment access impacts the relationship between adult opioid use and NAS.

Methods We conducted a cross-sectional state-level ecologic study using 36 states with available Healthcare Cost and Utilization Project State Inpatient Databases in 2014. Opioid use disorder treatment access was determined by the: 1) proportion of people needing but not receiving substance use treatment, 2) density of buprenorphine-waivered physicians, and 3) proportion of individuals in outpatient treatment programs (OTPs). The incidence of …

A Systematic Review Of Cases Of Meningitis In The Absence Of Cerebrospinal Fluid Pleocytosis On Lumbar Puncture, Michelle Troendle, Alexis Pettigrew

Emergency Medicine Publications

Background: Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF.

Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject.

Methods: Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. …

Targeting Intracellular Calcium Stores Alleviates Neurological Morbidities In A Dfp-Based Rat Model Of Gulf War Illness, Laxmikant Deshpande, Edna Santos, Kristin Phillips, Robert Blair

Neurology Publications

Gulf War Illness (GWI) is a chronic multi-symptom disorder afflicting the veterans of the First Gulf War, and includes neurological symptoms characterized by depression and memory deficits. Chronic exposure to organophosphates (OP) is considered a leading cause for GWI, yet its pathobiology is not fully understood. We recently observed chronic elevations in neuronal Ca2+ levels ([Ca2+]i) in an OP- diisopropyl fluorophosphate (DFP) based rat model for GWI. This study was aimed at identifying mechanisms underlying elevated [Ca2+]i in this DFP model and investigating whether their therapeutic targeting could improve GWI-like neurological morbidities. Male Sprague-Dawley rats (9-wks) were exposed to DFP …

Use Of Endoloop In Video-Assisted Thoracoscopic Enucleation Of A Very Rare Esophageal Tumor, Yahya Alwatari, Wayne Tse, Kasia Trebska-Mcgowan, Rachit D. Shah

Surgery Publications

A gastrointestinal stromal tumor is an infrequent tumor of the gastrointestinal tract with very rare involvement of the esophagus. We present a case of a patient with dysphagia and a 4 cm submucosal mass. The patient underwent thoracoscopic enucleation with complete resection of the mass. We present case details and operative video highlighting the important surgical steps of exposure and retraction. We believe that the Endoloop is a very useful tool in providing countertraction needed during minimally invasive resection of such lesions.

Loneliness In Later Life, Edward F. Ansello

Director's Editorials from Age in Action

The National Social Life, Health and Aging Project (NSHAP) at the University of Chicago notes that persistent loneliness in later life is the exception rather than the rule. When it occurs, it’s most likely to be a transient condition and remediable.

Blue Zones And Longevity, Edward F. Ansello

Director's Editorials from Age in Action

We can embrace the generalizable characteristics of Blue Zones: a plant-based diet, friendships, spiritual or religious grounding, awareness of and immersion in our community, physical activity as a regular, normalized part of our daily routine, and, more philosophically, an opening up to our own sense of place and purpose.

Dementia-Friendly Resources, Edward F. Ansello

Director's Editorials from Age in Action

While dementia caregiving challenges continue for individual caregivers and communities, Alzpossible.org and Dementia Friendly America (dfamerica.org) can offer immediate support and a hopeful vision.

Interprofessional Geriatrics: Improving The Health Of Older Adults, Edward F. Ansello

Director's Editorials from Age in Action

We have received a five-year award (2019-2024) from the federal Health Resources and Services Administration (HRSA) to grow our Virginia Geriatric Education Center (VGEC) project, which aims to improve health outcomes across Virginia for older adults by developing a healthcare workforce that maximizes patient and family engagement, integrating geriatrics and primary care, and demonstrating measurable impact.

The Mason Music & Memory Initiative (M3i), Catherine J. Tompkins, Emily S. Ihara, Megumi Inoue, Christi Clark, Kristen Suthers Rumrill

Case Studies from Age in Action

Educational Objectives

1. Explain the benefits of a nonpharmacological intervention, such as the M3I, for persons with dementia.

2. Describe the work of M3I and its collaboration with students and faculty throughout the state.

3.Highlight lessons learned and future directions for the M3I.