Medical Specialties Commons^™

Pediatric Rheumatology: Addressing The Transition To Adult-Orientated Health Care., Sara Sabbagh, Tova Ronis, Patience H White

Medicine Faculty Publications

The transition from pediatric to adult health care is often a challenging process due to multiple interwoven complexities, especially for children with chronic medical conditions. Health care transition (HCT) is a process of moving from a pediatric to an adult model of health care with or without a transfer to a new clinician. This paper focuses on what is known about HCT for youth and young adults (Y/YA) with rheumatic diseases within a larger context of HCT recommendations. HCT barriers for youth, families, and providers and current evidence for a structured HCT processes are reviewed. Practical advice is offered on …

Gut Microbiota And Cardiovascular Uremic Toxicities, Manuel T. Velasquez, Patricia Centron, Ian Barrows, Rama Dwivedi, Dominic S. Raj

Medicine Faculty Publications

Cardiovascular disease (CVD) remains a major cause of high morbidity and mortality in patients with chronic kidney disease (CKD). Numerous CVD risk factors in CKD patients have been described, but these do not fully explain the high pervasiveness of CVD or increased mortality rates in CKD patients. In CKD the loss of urinary excretory function results in the retention of various substances referred to as “uremic retention solutes”. Many of these molecules have been found to exert toxicity on virtually all organ systems of the human body, leading to the clinical syndrome of uremia. In recent years, an increasing body …

A Case Of Eosinophilic Annular Erythema As A Presenting Sign For Autoimmune Hepatitis, Olabola Awosika, Kristin Totoraitis, Misty Eleryan, Monica Rengifo-Pardo, Alison Ehrlich

Dermatology Faculty Publications

Eosinophilic annular erythema (EAE) is a relatively new entity, clinically presenting as a figurate erythema. The cause of EAE remains obscure, but it has been associated with several chronic conditions and malignancies. We describe an unusual case of EAE developing before the onset of autoimmune hepatitis.

Profile Of Dupilumab And Its Potential In The Treatment Of Inadequately Controlled Moderate-To-Severe Atopic Dermatitis., Olabola Awosika, Lori Kim, Momina Mazhar, Monica Rengifo-Pardo, Alison Ehrlich

Dermatology Faculty Publications

Atopic dermatitis (AD) is a common inflammatory skin disorder that manifests as eczematous lesions, often associated with allergic rhinitis and asthma. Historically, moderate-to-severe disease has been managed with systemic immunosuppression, such as oral corticosteroids, which result in relapse and limiting side effects. Due to recent advancements in the identification of interleukin (IL)-4 and IL-13 as key mediators in AD, new biological agents have been developed for treatment. Dupilumab is a recently approved monoclonal antibody that targets the alpha subunit of the IL-4 receptor and, thus, downregulates activity of IL-4 and IL-13. This review discusses the profile of dupilumab and its …

Association Of Two Foxp3 Polymorphisms With Breast Cancer In Chinese Han Women, Wenge Zhu, +Several Additional Authors

Biochemistry and Molecular Medicine Faculty Publications

Background

Forkhead box P3 (FOXP3) is a key gene in the immune system which also plays a role in tumor development. This study aims to explore the association of two FOXP3 polymorphisms (rs3761548 and rs3761549) with susceptibility to breast cancer (BC).

Method

A case–control study was conducted, involving 560 patients and 583 healthy individuals from the Chinese Han population. The genotypes of FOXP3 polymorphisms were detected using the Sequenom MassARRAY method. The association between FOXP3 polymorphisms and BC risk was evaluated using a χ2 test with an odds ratio (OR) and 95% confidence intervals (95% CIs) under six …

Aberrant Brain Functional Connectivity In Newborns With Congenital Heart Disease Before Cardiac Surgery, Josepheen De Asis-Cruz, Mary T. Donofrio, Gilbert Vezina, Catherine Limperopoulos

Pediatrics Faculty Publications

Newborns with congenital heart disease (CHD) requiring open heart surgery are at increased risk for neurodevelopmental disabilities. Recent quantitative MRI studies have reported disrupted growth, microstructure, and metabolism in fetuses and newborns with complex CHD. To date, no study has examined whether functional brain connectivity is altered in this high-risk population after birth, before surgery. Our objective was to compare whole-brain functional connectivity of resting state networks in healthy, term newborns (n = 82) and in term neonates with CHD before surgery (n = 30) using graph theory and network-based statistics. We report for the first time intact global network …

Comparison Between Different Strategies Of Rheumatic Heart Disease Echocardiographic Screening In Brazil: Data From The Provar (Rheumatic Valve Disease Screening Program) Study, B Nascimento, Craig A. Sable, M Nunes, A Diamantino, K Oliveira, Andrea Z. Beaton, +Several Additional Authors

Pediatrics Faculty Publications

Background-—Considering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease (RHD), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent RHD in schoolchildren (aged 5–18 years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil.

Methods and Results-—The PROVAR (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for RHD echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart …

Treatment Challenges In An Atypical Presentation Of Tubulointerstitial Nephritis And Uveitis (Tinu), S Caplash, S Gangaputra, S Kodati, Shamir Tuchman, Hemalatha Srinivasalu, H Sen

Pediatrics Faculty Publications

Purpose: To describe an atypical presentation of Tubulointerstitial Nephritis and Uveitis (TINU), with challenges in treatment course. Observations: A 12-year-old Hispanic female presented to the National Eye Institute's Uveitis clinic with bilateral blurred vision, red eyes and photophobia, not responsive to topical steroids. On exam, she had bilateral severe panuveitis with areas of subretinal fluid. During her evaluation, she was noted to have elevated serum creatinine. A kidney biopsy confirmed the presence of severe tubulointerstitial nephritis and interstitial fibrosis. She was treated with oral steroids with excellent resolution of symptoms and subretinal fluid. She continued to have anterior segment flares …

The Neurodevelopmental Perspective Of Surgical Necrotizing Enterocolitis: The Role Of The Gut-Brain Axis., Chariton Moschopoulos, Panagiotis Kratimenos, Ioannis Koutroulis, Bhairav V Shah, Anja Mowes, Vineet Bhandari

Pediatrics Faculty Publications

This state-of-the-art review article aims to highlight the most recent evidence about the therapeutic options of surgical necrotizing enterocolitis, focusing on the molecular basis of the gut-brain axis in relevance to the neurodevelopmental outcomes of primary peritoneal drainage and primary laparotomy. Current evidence favors primary laparotomy over primary peritoneal drainage as regards neurodevelopment in the surgical treatment of necrotizing enterocolitis. The added exposure to inhalational anesthesia in infants undergoing primary laparotomy is an additional confounding variable but requires further study. The concept of the gut-brain axis suggests that bowel injury initiates systemic inflammation potentially affecting the developing central nervous system. …

The Pathology Workforce And Clinical Licensure, Robin Lorenz, Donald S. Karcher, Michael Gautreaux, Melvin Limson, Dani Zander

Pathology Faculty Publications

There has been a recent recognition of the need to prepare PhD-trained scientists for increasingly diverse careers in academia, industry, and health care. The PhD Data Task Force was formed to better understand the current state of PhD scientists in the clinical laboratory workforce and collect up-to-date information on the training and certification of these laboratorians. In this report, we summarize the findings of the PhD Data Task Force and discuss the relevance of the data collected to the future supply of and demand for PhD clinical laboratory scientists. It is clear that there are multiple career opportunities for PhD …

Pd-L1 Checkpoint Inhibition And Anti-Ctla-4 Whole Tumor Cell Vaccination Counter Adaptive Immune Resistance: A Mouse Neuroblastoma Model That Mimics Human Disease., Priya Srinivasan, Xiaofang Wu, Mousumi Basu, Christopher Rossi, Anthony D Sandler

Pathology Faculty Publications

BACKGROUND: Adaptive immune resistance induces an immunosuppressive tumor environment that enables immune evasion. This phenomenon results in tumor escape with progression and metastasis. Programmed cell death-ligand 1 (PD-L1) expressed on tumors is thought to inhibit tumor-infiltrating lymphocytes (TILs) through programmed cell death 1 (PD1), enabling adaptive immune resistance. This study investigates the role of PD-L1 in both mouse and human neuroblastoma immunity. The consequence of PD-L1 inhibition is characterized in the context of an established whole tumor cell vaccine.

METHODS AND FINDINGS: A mouse model of neuroblastoma was investigated using an Id2 knockdown whole cell vaccine in combination with checkpoint …

Project Anacostia, Lapoldeon Williams, Abenezer Lemma, Janae Thomas, Kafoued Ouedraogo

DC Health and Academic Prep Program (DC HAPP)

Objectives Project Anacostia aims to [1] help meet the Healthy People 2020 goal of reducing the disease burden of diabetes mellitus (DM) and improving the quality of life for all persons who have, or are at risk for, DM as outlined by the U.S. Department of Health and Human Services. [2] To increase community awareness of the social determinants of health related to obesity and diabetes. [3] Increase access to recreational facilities and healthy food options in Wards 7 &8 and [4] promote healthy lifestyle choices among youth in the Anacostia community.

Methods Our intervention is comprised of three progressive …

Epha2/Ephrin-A1 Mediate Corneal Epithelial Cell Compartmentalization Via Adam10 Regulation Of Egfr Signaling., Nihal Kaplan, Rosa Ventrella, Han Peng, Sonali Pal-Ghosh, Constadina Arvanitis, Joshua Z Rappoport, Brian J Mitchell, Mary Ann Stepp, Robert M Lavker, Spiro Getsios

Anatomy and Regenerative Biology Faculty Publications

Purpose: Progenitor cells of the limbal epithelium reside in a discrete area peripheral to the more differentiated corneal epithelium and maintain tissue homeostasis. What regulates the limbal-corneal epithelial boundary is a major unanswered question. Ephrin-A1 ligand is enriched in the limbal epithelium, whereas EphA2 receptor is concentrated in the corneal epithelium. This reciprocal pattern led us to assess the role of ephrin-A1 and EphA2 in limbal-corneal epithelial boundary organization.

Methods: EphA2-expressing corneal epithelial cells engineered to express ephrin-A1 were used to study boundary formation in vitro in a manner that mimicked the relative abundance of these juxtamembrane signaling proteins in …

A Checklist For Clinical Trials In Rare Disease: Obstacles And Anticipatory Actions-Lessons Learned From The For-Dmd Trial, R Crow, K Hart, M Mcdermott, R Tawil, W Martens, Mathula Thangarajh, +Several Additional Authors

Neurology Faculty Publications

Background: Trials in rare diseases have many challenges, among which are the need to set up multiple sites in different countries to achieve recruitment targets and the divergent landscape of clinical trial regulations in those countries. Over the past years, there have been initiatives to facilitate the process of international study set-up, but the fruits of these deliberations require time to be operationally in place. FOR-DMD (Finding the Optimum Steroid Regimen for Duchenne Muscular Dystrophy) is an academic-led clinical trial which aims to find the optimum steroid regimen for Duchenne muscular dystrophy, funded by the National Institutes of Health (NIH) …

Effects Of Clinical Pathway Implementation On Antibiotic Prescriptions For Pediatric Community-Acquired Pneumonia., Daniele Donà, Silvia Zingarella, Andrea Gastaldi, Rebecca Lundin, Giorgio Perilongo, Anna Chiara Frigo, Rana F Hamdy, Theoklis Zaoutis, Liviana Da Dalt, Carlo Giaquinto

Pediatrics Faculty Publications

BACKGROUND: Italian pediatric antimicrobial prescription rates are among the highest in Europe. As a first step in an Antimicrobial Stewardship Program, we implemented a Clinical Pathway (CP) for Community Acquired Pneumonia with the aim of decreasing overall prescription of antibiotics, especially broad-spectrum.

MATERIALS AND METHODS: The CP was implemented on 10/01/2015. We collected antibiotic prescribing and outcomes data from children aged 3 months-15 years diagnosed with CAP from 10/15/2014 to 04/15/2015 (pre-intervention period) and from 10/15/2015 to 04/15/2016 (post-intervention period). We assessed antibiotic prescription differences pre- and post-CP, including rates, breadth of spectrum, and duration of therapy. We also compared …

Protocol For A Feasibility Study Of Group-Based Focused Psychosocial Support To Improve The Psychosocial Well-Being And Functioning Of Adults Affected By Humanitarian Crises In Nepal: Group Problem Management Plus (Pm+), M Sangrawla, E Van Hof, N Luitel, E Turner, K Marahatta, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background

The prevalence of common mental disorders increases in humanitarian emergencies while access to services to address them decreases. Problem Management Plus (PM+) is a brief five-session trans-diagnostic psychological WHO intervention employing empirically supported strategies that can be delivered by non-specialist lay-providers under specialist supervision to adults impaired by distress. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the efficacy of individuallydelivered PM+. To make PM+ more scalable and acceptable in different contexts, it is important to develop a group version as well, with 6–8 participants in session. A study is needed to demonstrate the feasibility and …

Spotlight On Once-Monthly Long-Acting Injectable Aripiprazole And Its Potential As Maintenance Treatment For Bipolar I Disorder In Adult Patients., Vanessa Torres-Llenza, Pooja Lakshmin, Daniel Z Lieberman

Psychiatry and Behavioral Sciences Faculty Publications

The lack of long-term medication adherence is a challenge in the treatment of bipolar disorder, particularly during the maintenance phase when symptoms are less prominent. The rate of nonadherence is ~20%-60% depending on how strict a definition is used. Nonadherence worsens the course of bipolar disorder and can add hundreds of thousands of dollars to the lifetime cost of treating the illness. Long-acting injectable (LAI) medication is an attractive alternative to daily dosing of oral medication, especially among patients who are ambivalent about treatment. The purpose of this paper is to review the evidence for the safety and efficacy of …

Review Of Risk Assessment Tools To Predict Morbidity And Mortality In Elderly Surgical Patients Brief Title: Review Of Surgical Risk Assessment Tools, Gilgamesh Eamer, Mohamed Al-Amoodi, Jayna Holroyd-Leduc, Darryl Rolfson, Lindsey Warkentin, Rachel Khadaroo

School of Medicine and Health Sciences Student Works

Background

Informed surgical consent requires accurate estimation of risks and benefits. Multiple risk assessment tools are available; however, most are not widely used or are specific to certain interventions. Assessing surgical risk is especially challenging in elderly patients because of their range of comorbidities, level of frailty, or severity of illness and a number of available surgical interventions.

Data sources

We searched MEDLINE from January 2014 to July 2017 for studies that used risk assessment tools in studies on elderly surgical patients. We then sought the original articles describing each assessment tool and subsequent validation studies.

Conclusions

We identified risk …

Antiretroviral Therapy Interruptions: Impact On Hiv Treatment And Transmission., Gueorgui Dubrocq, Natella Rakhmanina

Pediatrics Faculty Publications

Introduction: Successful management of pediatric and adult human immunodeficiency virus (HIV) disease includes lifelong administration of antiretroviral therapy (ART). The need for the continuous use of antiretroviral drugs throughout the life course poses a challenge to children, adolescents, and adults living with HIV and their caregivers. Historically, treatment interruptions have been viewed as a negative therapeutic strategy. Recently, however, treatment interruptions or treatment reduction strategies have become a focus of investigations as innovative approaches to the long-term management of HIV disease. Current challenges with treatment interruptions include identifying an appropriate timeframe for length of interruptions and identifying HIV patient populations …

Are Children Of A Diabetic Mother In Comparison To Children Of A Nondiabetic Mother At An Increased Risk For Developing Obesity In The First 10 Years Of Life?, Chhorn Pho

Theses and Graduate Projects

Body weight, glucose, insulin, and leptin were studied in children of mothers with gestational diabetes, type 1 or type 2 diabetes. Breast milk of diabetic mothers was also analyzed to study its relationship to childhood obesity. In the first 2 years of life, infants of mothers with gestational diabetes have no significant difference in weight gain but by the age of 10, most of the children birthed by any diabetic mothers were either overweight or obese. Children of mothers diagnosed with diabetes mellitus type 2 have higher resistance to insulin than children of mothers with other diabetes types. Leptin was …

Among Patients With Endometriosis, Does The Use Of Serum Biomarkers, Versus Laparoscopic Surgery For Diagnosis And Staging Of The Disease Decrease The Incidence Of Disease Related Negative Outcomes, Ellyn C. Hexum

Theses and Graduate Projects

Objective: To determine the ability and efficacy of non-invasive serum biomarker testing as a replacement for laparoscopic surgery in the diagnosis and staging of endometriosis to decrease the incidence of negative disease outcomes, leading to improvement in the accuracy of diagnoses and patient tailored treatment protocols.

Background: Endometriosis is a debilitating inflammatory disease of the reproductive tract. Currently, the gold standard for the diagnosis and staging of endometriosis is exploratory laparoscopic surgery. The use of surgery as the source of achieving a definitive diagnosis holds the potential to increase the incidence of negative disease outcomes. Because of this, the use …

Are Platelet Rich Plasma Injections A Better Choice Compared To Glucocorticoid Injections For The Treatment Of Rotator Cuff Tendinopathy In Adult Patients?, Sawyer Lange

Theses and Graduate Projects

An estimated 16 to 34 percent of the general population will experience shoulder pain at some point in their life. Rotator cuff tendinopathy makes up a large portion of that percentage. Platelet rich plasma (PRP) is an autologous blood product that has supraphsyiologic levels of growth factors and cytokines that have the potential to expedite the tendon healing process. This literature review will look at the current science surrounding PRP and look at studies comparing its efficacy to the commonly used corticosteroid injection.

Do Non-Steroidal Anti-Inflammatory Drugs Increase The Risk For Non- Or Mal-Union Following Acute Fracture? A Literature Review, Bryan Moritz

Theses and Graduate Projects

NSAID medications are among the most commonly used analgesic medications world wide, and it was estimated in 2010 (updated 2015 data is expected to be published next year) that about 29 million adults in the United States regularly used NSAID medications at least three times per week for more than three months. Fracture healing has been shown to be dependent on the inflammatory cascade. NSAID medication use appears to have a mechanistic in-vivo and in-vitro animal risk for the development of non- and mal-union following fracture. However, human data is lacking to support total avoidance of this analgesic option for …

Analysis Of Intrauterine Device Implementation And Review Of Prevention Strategies To Reduce Adolescent Pregnancy In Nicaragua, Haley Johnson

Theses and Graduate Projects

Adolescent pregnancy is one of the main healthcare issues facing Nicaragua. Prevention strategies are needed to avoid the maternal and fetal outcomes associated with young pregnancies. Extensive literature analysis and face-to-face discussions in Nicaragua were conducted to determine the current incidence of adolescent pregnancy and contraception use, barriers to reproductive health for adolescents, maternal outcomes of adolescent pregnancy, and if intrauterine devices have the potential to be a culturally effective method of contraception. Specific barriers to reproductive health for adolescents were identified to be machismo, societal criticism, lack of reproductive education, fear of infection from IUDs, and underutilization of healthcare …

Drug Therapy Vs. Ablation Therapy For Patients With Atrial Fibrillation, Jessica Ansara

Theses and Graduate Projects

The prevalence of atrial fibrillation is 6.5 percent in the adult population in the United States, in an attempt to treat this patient population, there are numerous options and this study attempts to find the optimal treatment plan that has the least Atrial fibrillation(AF) reoccurrence, best quality of life and is the most effective. This is a Systematic Review comparing catheter ablation therapy vs. drug therapy in treating patients with atrial fibrillation. The search engines used in this analysis include PubMed, UpToDate, Google Scholar and Academic Search Premier. A total of 19 articles were analyzed and data was extracted, and …

Access And Attitudes Regarding Emergency Contraception And Reproductive Health In Nicaragua, Nadia Commers

Theses and Graduate Projects

Unintended pregnancy affects millions of women across the globe and often leads to an increased risk of health complications and socio-economic stress. In Nicaragua, approximately 1 in 6 births are unplanned, a relatively low number in comparison to the United States. However, the rate of unintended pregnancy is particularly problematic within the adolescent age group of Nicaragua, where 50% of women give birth before age 20 and 45% of those births are unplanned. The annual fertility rate of Nicaragua’s adolescents (109 births per 1,000 15-19- year-olds) is the highest in all of North, Central and South America, where the average …

Analysis Of The Effects Of Music Therapy On Pain And Anxiety Levels In Pediatric Burn Patients, Maria Cook

Theses and Graduate Projects

Burn injuries resulting in tissue damage are considered one of the most severe traumas that can be experienced. Pain and anxiety continue to be major problems for patients with burn injuries during all stages of the treatment. Proper pain management is essential during recovery because it reduces the chance of developing malnutrition and promotes a stronger immune system. A number of studies have explored the effects of music on pain levels before, during, and after medical procedures for burn patients. Few studies have examined the effects of music therapy in the population of pediatric burn patients. Many studies have shown …

Therapeutic Hypothermia For Neonatal Hypoxic Ischemic Encephalopathy: Effects On Neurodevelopmental Outcomes, Claire Rustad

Theses and Graduate Projects

Therapeutic hypothermia is a standardized protocol in the management of term- or near- term neonates who have suffered asphyxia in the perinatal period. Birth asphyxia, if sustained, may develop into a more serious condition known as hypoxic ischemic encephalopathy (HIE). Depending on severity, HIE is associated with adverse cognitive and neurodevelopmental outcomes, yet through various physiological mechanisms, hypothermia sustained for a 72-hour period has been shown to attenuate, or even prevent, permanent brain damage by decreasing cerebral energy demands. Unfortunately, cognitive and neurodevelopmental outcomes are difficult to prognosticate before or after completion of hypothermia protocol, but existing standards and technology …

In Developing Countries, Does The Implementation Of Basic Cardio-Pulmonary Resuscitation Education In The Community Improve Patient Outcomes?, Ashley Gross

Theses and Graduate Projects

Circulatory shock and cardiovascular diseases contribute to significant mortality globally, with an increased burden in developing countries. The compilation of these studies and anecdotal support gathered while in Nicaragua supports the impact education on high-quality CPR among the community can have on out-of- hospital cardiac arrest patient outcomes. Even though some studies showed guideline-compliant CPR does not improve all patient outcomes, we cannot estimate the time it will take a patient to achieve ROSC. Therefore, educating the public and refining the skills of health care professionals can have a significant positive impact on out-of-hospital cardiac arrest patient outcomes if there …

The Effectiveness Of Video And Other Electronic Media On Dnr/Dni Decisions Within Advance Care Planning, Peter Seebarg

Theses and Graduate Projects

Advance Care Planning is used to ensure patients’ wishes and preferences for treatment are in line with their medical situation. Its use has increased over the past years, but it has been implemented in a piece wise and unorganized fashion. Changes in provider billing capabilities and a recent consensus definition and implementation strategies of Advance Care Planning have created an opportunity to research and explore best use practices. A key feature of Advance Care Planning is creating autonomy for patients’ decisions. Autonomy is especially important for the use of cardiopulmonary resuscitation (CPR) in the event of a medical crisis.

Research …