Medical Specialties Commons^™

Childhood Idiopathic Pulmonary Hypertension: A Case Report, Nathaniel Balmert, Joseph Prahlow

Research Day

Introduction: Pulmonary arterial hypertension (PAH) is characterized as average pulmonary artery pressure of greater than 25mm Hg at rest. Childhood idiopathic pulmonary hypertensions (CIPH) is distinguishable from PAH by the absence of family history or underlying disease. Symptoms of CIPH include dyspnea, exercise limitation, and syncope. Common organ-specific changes include right ventricular hypertrophy and right ventricular strain. We present the case of a 6-year-old girl presenting with idiopathic pulmonary arterial hypertension aggravated by esophageal intubation. Methods: This case is from the files of one of the authors, a forensic pathologist. Case Report and Discussion: Diagnosed with pulmonary arterial hypertension when …

A Case Of Native Valve Staphylococcus Epidermidis Endocarditis With Cardiac Abscess Formation, Emily Cordes, Chris Jacob, Mark Loehrke

Research Day

Introduction: Staphylococcus epidermidis is the most common commensal bacteria of the skin; however it can be pathogenic and is the most frequent cause of medical device associated endocarditis. It is also a well-known cause of endocarditis in IV drug abuse (IVDA). However, in individuals without obvious disruption of the skin barrier, it is a relatively rare, but emerging entity of native valve endocarditis. Coagulase negative staphylococci account for only 1-5% of community acquired native valve infective endocarditis and most resolve with treatment. We report a case of a 56 year old male with an aggressive strain of community acquired Staphylococcus …

Challenges In The Diagnosis And Management Of Pediatric Pulmonary Tuberculosis In Madagascar, Emily Cordes, Richard Roach

Research Day

Introduction: Tuberculosis (TB) remains an important cause of morbidity and mortality in Madagascar. According to the World Health Organization (WHO), in 2015, the estimated incidence of TB was 57,000 and 11,000 of those cases were of patients less than 14 years old. Of the reported cases, 89% were bacteriologically confirmed. However, it is well established that bacteriologic confirmation of TB in children is especially difficult. Therefore, the incidence of TB in the pediatric population in Madagascar, and likely worldwide, is under estimated. We report a case of a 4 year old male that illustrates the challenges in diagnosis and management …

Widening The Differential: A Case Of Hemophagocytic Lymphohistiocytosis Disguised As A Fever Of Unknown Origin, Emily Cordes

Research Day

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is an under recognized, aggressive inflammatory disease characterized by excessive activity of histiocytes and lymphocytes. According to the HLH-2004 guidelines, five of the following eight criteria must be met to diagnose HLH: fever >38.5¡ã C, splenomegaly; cytopenias affecting ¡Ý two cell lines; hypertriglyceridemia/hypofibrinogenemia; evidence of hemophagocytosis in the bone marrow, spleen or lymph nodes; hyperferritinemia; low NK cell activity; or high levels of soluble CD25. Once a diagnosis of HLH is established, investigations for infectious, malignant or autoimmune etiologies must be pursued. We report a case of fever of unknown origin (FUO) that presented multiple times …

Social Determinants - Impacting Or Causing Disparities In Patient Care?, Shaena Faye Freeman Md, Kristi Vanderkolk Md

Research Day

Health disparities secondary to social factors including socioeconomic status, race, gender and ethnicity are well known to the health community and are a troubling issue in the United States. Social determinants are defined by the WHO as the structural “conditions people are born, live, grow, work and age in…determined by wealth distribution and available resources…that are mostly responsible for health inequalities.” We present here the case of TL, a 49 year old African American female who presented to the emergency department three times with atypical coronary disease symptoms in the setting of recent NSTEMI with subsequent 3 vessel CABG. At …

Cryptococcal Empyema: A Rare Manifestation Of Disease, Mohamed Mortagy, Larry Lutwick, Stephen Breisach

Research Day

Introduction: Cryptococcus neoformans is a pathogenic yeast that is generally acquired by man from the environment via the respiratory route. Despite this route of acquisition, overt pulmonary infection is uncommonly diagnosed and the disease is usually manifest as a subacute meningitis which is mostly manifest in individuals who are celluarly immunoincompetent such as those on cancer chemotherapy, receiving anti-solid organ rejection medications and those with HIV/AIDS. Infection of the pleural space with C. neoformans is quite uncommon. We report a non-immunosuppressed man who was found to have infection of the pleural in the wake of bacterial empyema who was successfully …

Infection-Associated Mycobacterium Fortuitum Infection, Dennis T. Huang, Larry Lutwick

Research Day

Introduction: Mycobacterial species are unusual causes of skin and soft tissue infections and can be difficult to diagnose in the absence of consideration as they often require specific culture media and longer incubation times. We report a Mycobacterium fortuitum subcutaneous abscess in a diabetic related to medication injection that was initially diagnosed without specialized media or prolonged incubation times. Case Report: A 48 year old diabetic female developed a progressive subcutaneous swelling in the tissues of the right lower abdominal wall where she had been injecting liraglutide. Because of continued enlargement "to almost egg size" with pain, she was empirically …

Acute Hypoxic Respiratory Failure As A Complication Of A Urinary Tract Infection During Pregnancy: A Case Presentation, Manpreet S. Narwal, Susan Jevert-Eichorn, Narinder Nina Clair

Research Day

Urinary tract infections (UTI), as well as asymptomatic bacteriuria, have the potential to cause serious morbidity during pregnancy making it imperative to identify and treat them promptly. If left untreated, a UTI can lead to pyelonephritis and sepsis. More importantly, UTIs are independently associated with intrauterine growth restriction (IUGR), premature rupture of membranes (PROM), preterm delivery, pulmonary edema, acute respiratory distress syndrome (ARDS), preeclampsia, and cesarean delivery. We report the case of NC, a 19 year old G1P0 at 36 weeks and 3 days GA who presented to the hospital with concern for rupture of membranes with associated back and …

Prediction And Benefits Of Minimal Disease Activity In Patients With Psoriatic Arthritis And Active Skin Disease In The Adept Trial., Philip Mease, Arthur Kavanaugh, Laura C Coates, Iain B Mcinnes, Maja Hojnik, Ying Zhang, Jaclyn K Anderson, Alexander P Dorr, Dafna D Gladman

Articles, Abstracts, and Reports

Objectives: To determine the proportion of patients with psoriatic arthritis in the Adalimumab Effectiveness in Psoriatic Arthritis trial achieving minimal disease activity (MDA) and its individual components at 1 or more visits over 144 weeks, identify baseline predictors of MDA achievement, and evaluate the association of MDA status with independent quality of life (QoL)-related patient-reported outcomes (PROs).

Methods: Univariate and multivariate analyses were used to identify the baseline characteristics that predicted achievement of MDA at individual time points (weeks 12 through 144) or sustained MDA (achievement of MDA at 2 consecutive time points 12 weeks apart). The association of independent …

A Novel Design Of A Phase Iii Trial Of Isradipine In Early Parkinson Disease (Steady-Pd Iii), Kevin M. Biglan, David Oakes, Anthony E. Lang, Robert A. Hauser, Karen Hodgeman, Brittany Greco, Jillian Lowell, Rebecca Rockhill, Ira Shoulson, Charles Venuto, Diony Young, Tanya Simuni

Neurology Faculty Publications

Objectives To describe the rationale for a novel study design and baseline characteristics of a disease-modifying trial of isradipine 10 mg daily in early Parkinson disease (PD).

Methods STEADY-PDIII is a 36-month, Phase 3, parallel group, placebo-controlled study of the efficacy of isradipine 10 mg daily in 336 participants with early PD as measured by the change in the Unified Parkinson Disease Rating Scale (UPDRS) Part I-III score in the practically defined ON state. Secondary outcome measures include clinically meaningful measures of disability progression in early PD: (1) Time to initiation and utilization of dopaminergic therapy; (2) Time to onset …

Serotonin Syndrome Complicating Treatment Of Ifosfamide Neurotoxicity With Methylene Blue, Matthew Snyder, Suhas Gangadhara, Andrew S. Brohl, Steven Ludlow, Sowmya Nanjappa

Neurology Faculty Publications

Methylene blue is a widely used treatment for ifosfamide neurotoxicity. We present a case of severe encephalopathy complicating ifosfamide-based therapy for recurrent retroperitoneal leiomyosarcoma. After treatment with methylene blue, the patient experienced clinical decompensation and was diagnosed with serotonin syndrome based on a constellation of clinical findings. Withdrawal of methylene blue and other serotonergic medications led to clinical stabilization and ultimately neurological recovery. Our case highlights the challenge of diagnosing serotonin syndrome in the face of preexisting ifosfamide neurotoxicity, as there is significant clinical overlap between these 2 syndromes. Practitioners must remain vigilant of this potential life-threatening complication in this …

Vital Signs, Winter 2017, Boonshoft School Of Medicine

Vital Signs

A forty eight page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, a research spotlight, alumni notes, and more.

Genetic Variation In The Histamine Production, Response, And Degradation Pathway Is Associated With Histamine Pharmacodynamic Response In Children With Asthma, Bridgette L. Jones, Catherine M.T. Sherwin, Xiaoxi Liu, Hongying Dai, Carrie A. Vyhlidal

Pediatrics Faculty Publications

Introduction: There is growing knowledge of the wide ranging effects of histamine throughout the body therefore it is important to better understand the effects of this amine in patients with asthma. We aimed to explore the association between histamine pharmacodynamic (PD) response and genetic variation in the histamine pathway in children with asthma.

Methods: Histamine Iontophoresis with Laser Doppler Monitoring (HILD) was performed in children with asthma and estimates for area under the effect curve (AUEC), maximal response over baseline (Emax), and time of Emax (Tmax) were calculated using non-compartmental analysis and non-linear mixed-effects model with a linked effect PK/PD …

Evaluating Adherence To The Sepsis Bundle And The Effectiveness Of Best Practice Alerts, Kate M. Burnett

DNP Projects

PURPOSE: To evaluate the adherence to the CMS sepsis recommendations and sepsis bundle used by the study health system before and after the implementation of Best Practice Alerts (BPAs) and assessing the effect of these alerts on patient outcomes.

METHODS: The study was a single-center, process evaluation through a retrospective chart review within a southwest healthcare system. The sample consisted of 73 patients for the pre-implementation period (May 1, 2016-September 7, 2016) and 75 patients for the post-implementation period (September 8, 2016-April 30, 2017).

RESULTS: No major differences were found between the two groups with regard to patient age, ethnicity, …

Thyroid Ultrasound: State Of The Art Part 1 - Thyroid Ultrasound Reporting And Diffuse Thyroid Diseases, Manjiri Dighe, Richard Barr, Jörg Bojunga, Vito Cantisani, Maria Cristina Chammas, David Cosgrove, Xin-Wu Cui, Yi Dong, Franziska Fenner, Maija Radzina, Sudhir Vinayak, Jun-Mei Xu, Christoph F. Dietrich

Imaging & Diagnostic Radiology, East Africa

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

Use Of Personalized Patient Heart Diagrams At The Bedside To Improve Quality Of Care, Melissa D. Elliott

Posters

Title: Use of personalized patient heart diagrams at the bedside to improve quality of care

Background/Introduction: With congenital heart disease no two hearts are exactly the same. Even with the same lesion, the anatomy of the heart can be completely different. In response to a bedside nursing idea following a cardiac arrest, advanced practice nurses (APN) initiated a program to provide personalized cardiac anatomy diagrams at the bedside of every patient on the cardiology service.

Methods: When a cardiac patient is admitted to cardiology floor, the nurse will check the patients chart for an anatomy picture, then will place …

Pre-Implementation Of A Fontan Post-Operative Clinical Pathway: Summary Of 2016 Pdsa Cycles, Sarah M. Lagergren, Bryan Beaven, Suma Goudar, Megan Jensen

Posters

Background/Introduction: Post-operative hospitalization for the Fontan procedure tends to have an extended hospital length of stay (LOS). From 2013-2014, the average LOS at Children’s Mercy for the Fontan procedure is 14 days, whereas the U.S. national reported average is 11 days. Post-operative management of this patient population is often caregiver dependent. It has been theorized that developing a more standardized post-operative management regimen tailored specifically toward the unique physiology of Fontan patients may be able to improve outcomes and decrease LOS.

Methods: A review of literature was performed and revealed three pediatric institutions have published their post-operative Fontan care guidelines. …

Therapeutic Plasma Exchange (Tpe) Performed In Tandem With Crrt And/Or Ecmo: Experience Of One Pediatric Center, Lejla Music Aplenc, Cindy George, Kimberly Marriott

Posters

SUMMARY

The most common indications for starting tandem procedures were ASFA Category III indications, followed by un-categorized indications.

Similar to other reports in literature, hypocalcemia and hypotension were the most common complications. Transfusion reactions were rare, despite the use of large volumes of plasma.

Tandem procedures in critically ill pediatric patients require close monitoring and excellent communication between staff members.

An Expanded Role For Nurses In Laboratory Utilization, Marilyn S. Hamilton, Rangaraj Selvarangan, Michele Fix, Lynn E. Shriver

Posters

Introduction: The majority of laboratory testing errors occur in the pre-analytical stage, including specimen collection. Children provide special challenges including small blood volumes, small veins, and an inability to cooperate. We describe collaboration between laboratorians and nursing staff to improve specimen collection and the reliability of test results.

Methods: We identified three areas for improvement: 1) Volume of blood for culture, 2) Urine collection, and 3) Appropriate blood collection through a line. Base line data was established. Guidelines for specimen collection were updated. Nurse members of the Laboratory Utilization Committee developed educational tools.

Results: Nursing education was effective at improving …

Global Health Experience In Swaziland, Anik Patel

Posters

Describes a global health learning experience at the Baylor Center of Excellence in Swaziland, where diagnosis and treatment of HIV/AIDS and TB, along with maternal health, women's health, and adolescent care are provided.

Why Is Education Important In Ems?, Adriana Goad

A with Honors Projects

In EMS, education is vital. As prehospital healthcare providers, we must constantly be educating ourselves on the advances and changes that are made within our protocols and by research. Frequent renewal deadlines for the licenses we hold are put in place so that we remain competent in our skills and are up to date to the most current of standards. There is another factor to our professional need for education, and that is community education. By educating those around us, we can be a means of prevention. While EMS is our career and passion, we want nothing more than to …

Validity And Reliability Of The Balance Tracking System™ During Static Stance, Cody L. Grotewold

College of Graduate Studies: Theses & Dissertations

Introduction: The Balance Tracking System™ (BTrackS™) is a balance board designed to quickly analyze postural control through center of pressure (COP) analysis.

Purpose: Examine concurrent validity and test-retest reliability of the BTrackS™ during static stance.

Methods: A convenience sample of 51 healthy collegiate students between 18 - 25 years old (21.8 ± 3.1 years) completed four, 20 second (s) trials of feet together static stance during both eyes open and closed trials. Data was simultaneously collected on the BTrackS™ and a laboratory force plate to establish concurrent validity. A second testing session was administered 48 - 72 …

การใส่กางเกงรัดกล้ามเนื้อต่อการลดการสะสมแลคเตทที่เกิดจากการออกกำลังกายอย่างหนักในโปรแกรมที่ทำให้เกิดการล้าเฉพาะบาสเกตบอลในนักกีฬาบาสเกตบอลชาย, ธวัชชัย พลอยแดง

Chulalongkorn University Theses and Dissertations (Chula ETD)

วัตถุประสงค์ จุดมุ่งหมายของการศึกษานี้เพื่อศึกษาผลของการใส่กางเกงรัดกล้ามเนื้อต่อการลดแลคเตทในเลือดที่เกิดจากการล้าจากการออกกำลังกายแบบเฉพาะของบาสเกตบอลในนักกีฬาบาสเกตบอลชาย วิธีการศึกษา การศึกษาในรูป crossover design ในนักบาสเกตบอลที่มีทักษะสูง จำนวน 19 คน (อายุ 19.95 ± 1.87 ปี ค่าดัชนีมวลกาย 22.45 ± 1.36 กิโลกรัม/ตารางเมตร และค่าความสามารถการใช้ออกซิเจนสูงสุด 47.26 ± 2.83 มิลลิลิตร/กิโลกรัม/นาที) กำหนดรูปแบบให้ใส่กางเกงรัดกล้ามเนื้อ (แรงกดที่ผิวหนัง 16.71 ± 1.35 มิลลิเมตรปรอท) สลับกับกางเกงเลคกิ้ง (3.79 ± 1.47 มิลลิเมตรปรอท) ในลำดับการสุ่มที่เว้นระยะระหว่างโดยเว้นระยะห่างในแต่ละรูปแบบ 5 วัน ทำการวัดระดับความเข้มข้นของแลคเตทจากเลือดที่ปลายนิ้ว สมรรถภาพการกระโดดสูงสุด และ การวัดคลื่นสัญญาณไฟฟ้ากล้ามเนื้อ gastrocnemius ก่อนและหลังการออกกำลังกายแบบเฉพาะของบาสเกตบอล ผลการศึกษา ผลของกางเกงรัดกล้ามเนื้อขณะออกกำลังกายมีค่าแลคเตทในเลือดน้อยกว่ากลุ่มกางเกงเลคกิ้ง อย่างมีนัยสำคัญทางสถิติ (p<0.05) ค่า integrated electromyography และ median frequency ขณะใส่กางเกงรัดกล้ามเนื้อและกางเกงเลคกิ้งช่วงหลังออกกำลังกายเมื่อเปรียบเทียบกับก่อนออกกำลังกายลดลงแตกต่างอย่างมีนัยสำคัญทางสถิติ (p<0.05) ค่าสหสัมพันธ์ (correlation) ระหว่าง การเปลี่ยนแปลง median frequency กับการเปลี่ยนแปลงของระดับแลคเตทในเลือด มีค่าความสัมพันธ์ที่ r = .2 และ r = .47 ในขณะใส่กางเกงรัดกล้ามเนื้อและกางเกงเลคกิ้ง ตามลำดับ สรุปผล ผลการศึกษานี้แสดงให้เห็นว่ากลุ่มกางเกงรัดกล้ามเนื้อสามารถช่วยลดการสะสมของแลคเตทในเลือดขณะออกกำลังกายเฉพาะบาสเกตบอลที่ทำให้เกิดอาการล้าได้ดีกว่าเมื่อเปรียบเทียบกับการใส่กางเกงเลคกิ้ง

Importance Of Physical Activity In Women, Minaz Mawani

Department of Medicine

No abstract provided.

A Mixed Methods Study To Assess The Effectiveness Of Food-Based Interventions To Prevent Stunting Among Children Under-Five Years In Districts Thatta And Sujawal, Sindh Province, Pakistan: Study Protocol, Sumra Kureishy, Gul Nawaz Khan, Shabina Arrif,, Khizar Ashraf, Angela Cespedes, Atif Habib, Imtiaz Hussain, Asmat Ullah, Ali Turab, Imran Ahmed, Shehla Zaidi, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Maternal and child malnutrition is widely prevalent in low and middle income countries. In Pakistan, widespread food insecurity and malnutrition are the main contributors to poor health, low survival rates and the loss of human capital development. The nutritional status trends among children exhibit a continuous deteriorating with rates of malnutrition exceeding the WHO critical threshold. With the high prevalence of maternal and child malnutrition, it is important to identify effective preventative approaches, especially for reducing stunting in children under-five years of age. The primary aim of this study is to assess the effectiveness of food-based interventions to …

Prevalence And Possible Factors Associated With Anaemia, And Vitamin B 12 And Folate Deficiencies In Women Of Reproductive Age In Pakistan: Analysis Of National-Level Secondary Survey Data, Sajid Bashir Soofi, Gul Nawaz Khan, Kamran Sadiq, Shabina Ariff, Atif Habib, Sumra Kureishy, Imtiaz Hussain, Muhammad Umer, Zamir Suhag, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Objective: To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan.
Methods: A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels /dL, vitamin B12 deficiency as serum vitamin B12 levels of /mL (150 pmol/L) and folate deficiency as serum folate levels /mL (10 nmol/L).
Results: A total of 11 751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, …

Mass Deworming To Improve Developmental Health And Wellbeing Of Children In Low-Income And Middle-Income Countries: A Systematic Review And Network Meta-Analysis, Vivian A. Welch, Elizabeth Ghogomu, Alomgir Hossain,, Shally Awasthi, Zulfiqar Ahmed Bhutta, Chisa Cumberbatch, Robert Fletcher, Jessie Mcgowan, Shari Krishnaratne, Elizabeth Kristjansson

Department of Paediatrics and Child Health

Background: Soil-transmitted helminthiasis and schistosomiasis, considered among the neglected tropical diseases by WHO, affect more than a third of the world’s population, with varying intensity of infection. We aimed to evaluate the eff ects of mass deworming for soil-transmitted helminths (with or without deworming for schistosomiasis or cointerventions) on growth, educational achievement, cognition, school attendance, quality of life, and adverse effects in children in endemic helminth areas.

Methods: We searched 11 databases up to Jan 14, 2016, websites and trial registers, contacted authors, and reviewed reference lists. We included studies published in any language of children aged 6 months to …

Clinical And Laboratory Profile Of Children With Cystic Fibrosis: Experience Of A Tertiary Care Center In Pakistan, Danish Abdul Aziz, Abdul Gaffar Billoo, Ahad Qureshi, Misha Khalid, Salman Kirmani

Department of Paediatrics and Child Health

Objective: To determine the clinical presentation, diagnostic investigations and laboratory workup done in admitted children with cystic fibrosis at Aga Khan University Hospital Karachi, Pakistan.
Methods: This is a three years retrospective study from January 2013 to December 2015 conducted at The Aga Khan University Hospital Karachi Pakistan, enrolling admitted patient from birth to 15 years of either gender, diagnosed with CF on the basis of clinical features and positive sweat chloride test. Different clinical presentations were noted including initial presentations. Sweat chloride values more than 60mmol/L were labeled as positive and consistent with diagnosis of CF. Available Delta F-508 …

Equivalence And Non-Inferiority Trials In A Snapshot, Salima Kerai

Department of Paediatrics and Child Health

No abstract provided.

Slc11a1 Polymorphisms And Host Susceptibility To Cutaneous Leishmaniasis In Pakistan., Mariam Sophie,, Abdul L Hameed Institute Of Biomedical And Genetic Engineering (Ibge), 24-Mauve Area, G- 9/1, Islamabad, Pakistan., Akhtar Muneer, Azam J. Samdani, Saima Saleem, Abid Azhar

Department of Medicine

Background:The vector-borne cutaneous leishmaniasis (CL) is endemic in several regions of Pakistan mainly affecting poor populations. Host genetic factors, particularly SLC11A1 (solute carrier transmembrane protein) within macrophages, play a crucial role in disease pathology and susceptibility. Association of SLC11A1 with cutaneous leishmaniasis, a neglected tropical disease, is not well established. Inconsistencies have been observed within different populations worldwide with respect to genetic susceptibility. This study was designed to investigate genetic variation(s) in SLC11A1 and to assess possible association with cutaneous leishmaniasis in Pakistan.

Results: Eight polymorphisms (rs2276631, rs3731864, rs2290708, rs2695342, rs201565523, rs17215556, rs17235409, rs17235416) were genotyped across SLC11A1 in …