Medical Specialties Commons^™

Marijuana And Its Cardiovascular Implications, Albert Bui, Daniel Powell, Victoria Cho, Kelsey Lindsley, Lindsey Peters

Pharmacy and Wellness Review

As marijuana becomes legalized for medical use, it is important for prescribers and pharmacists to be knowledgeable about the important aspects of marijuana such as mechanism of action, indications and abuse potential. Although marijuana's medicinal benefits are frequently reported, the risks, namely cardiovascular risks, associated with its utilization are often overlooked. Use of marijuana has been reported to increase the risk of myocardial infarction, tachycardia and hypotension, among others. Health care providers must determine if marijuana's benefits outweigh such risks when marijuana therapy is an option. It is also important for pharmacists to understand how to successfully counsel patients using …

Fda Approves New Inhaled Insulin: Afrezza® (Technosphere® Insulin), Benjamin Finley, Christina Ciccone, Kimberly Loughlin, Michelle Musser

Pharmacy and Wellness Review

Diabetes is an endocrine disease caused by deficiency or malfunction of insulin that results in high blood glucose levels and places patients at higher risk for a number of complications. This chronic disease is difficult to manage and affects millions of people in the United States, costing the health care system billions of dollars a year. Of a variety of antidiabetic agents used to control blood glucose, insulin is perhaps the most effective, but until recently it was only available in injectable form. As of June 27, 2014, a new inhaled insulin called Afrezza® (Technosphere® insulin) was approved by the …

Management Of Breakthrough Pain In Cancer Patients: Traditional And Novel Approaches, Courtney Porter, Nathaniel Hedrick, Katherine Salay, Lacey Shumate, Caitlin Swann, Kelly Reilly Kroustos

Pharmacy and Wellness Review

Approximately 80 percent of career patients experience breakthrough pain (BTP) characterized by acute onset, short duration, and moderate-to-severe intensity. Treatment of BTP using current available medications is often insufficient, leading to the development of various novel approaches that focus on rapid onset of action and short duration of action. Most of these products are still in clinical trials, and future studies are needed to compare the novel approaches to currently available treatments. Non-medication related issues, which arise from a lack of communication and understanding between the patient, physician and pharmacist, are also barriers to adequate BTP management. By educating patients …

Prevention Of Cytomegalovirus Lntection In Pregnant Mothers And Neonates, Aisha Oliver, Taylor Gauthier, Breanne Rizzo, Alison Huet, Natalie Dipietro

Pharmacy and Wellness Review

Congenital cytomegalovirus (CMV) is the most common virus spread in utero from mother to fetus, leading to more long-term problems and childhood deaths than other conditions such as Down syndrome, fetal alcohol syndrome, pediatric HIV/AIDS, or neural tube defects. The majority of congenital CMV infections are primary infections in which the mother acquires the infection during pregnancy. Current treatment options for CMV infection are available, but there is limited data on safety and effectiveness in pregnant mothers and neonates. Prevention by screening for CMV is associated with a high cost, and vaccines are currently unavailable. Studies show that education and …

Polycystic Ovarian Syndrome And Hyperinsulinemia: Overview And Treatment, Amanda M. Meyer, Lauren D. Bajbus, Sarah E. Drake, Kristen M. Quertinmont, Ashley Overy, Anne Gentry

Pharmacy and Wellness Review

Polycystic ovary syndrome is a prevalent issue in women's health that is associated with hyperinsulinemia and insulin resistance and can lead to long-term health problems. The most highly recommended treatments are diet and lifestyle changes. If these changes alone are not enough, pharmacologic treatments may be employed which include metformin, spironolactone or thiazolidinediones, although more research is needed to fully realize their role. The role of the pharmacist in this disease state includes counseling patients on healthy lifestyle changes, consulting with the physician about prescribing the best medication for each patient, and monitoring therapy adherence in the patient.

Management Of Hypertensive Emergencies In Pediatrics, Jennifer L. Bauer, Jamie L. Amero, Amanda C. Mcdavid, Ryan A. Fischer, Alison L. Huet, Karen L. Kier

Pharmacy and Wellness Review

As hypertension becomes more prevalent in the pediatric population, clinicians are more likely to encounter hypertensive emergencies in children, which require pharmacists and physicians to be educated on the therapeutic options for these emergencies. However, the strict governmental requirements on the testing of these drugs in pediatric patients have limited the amount of available evidence on which to base clinical decisions. This review will highlight the available evidence and preferred treatment options for the management of pediatric hypertensive emergencies.

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 …

Osteopathy Comes To Kansas City: The National School And Infirmary, Robyn Oro

Notes from the Archives

No abstract provided.

Deworming Children For Soil-Transmitted Helminths In Low And Middle-Income Countries: Systematic Review And Individual Participant Data Network Meta-Analysis, Vivian Andrea Welch, Alomgir Hossain, Elizabeth Ghogomu, Alison Riddle, Simon Cousens, Michelle Gaffey, Paul Arora, Robert Black, Donald Bundy, Zulfiqar Ahmed Bhutta

Woman and Child Health

Intestinal parasites affect millions of children globally. We aimed to assess effects of deworming children on nutritional and cognitive outcomes across potential effect modifiers using individual participant data (IPD). We searched multiple databases to 27 March 2018, grey literature, and other sources. We included randomised and quasi randomised trials of deworming compared to placebo or other nutritional interventions with data on baseline infection. We used a random-effects network meta-analysis with IPD and assessed overall quality, following a pre-specified protocol. We received IPD from 19 trials of STH deworming. Overall risk of bias was low. There were no statistically significant subgroup …

Concurrent Discitis And A Spinal Epidural Abscess Following Transforaminal Epidural Steroid Injection Arising From An Unlikely Bacterial Species, Adlai Pappy Ii, Vinita Singh Md

Anesthesiology

No abstract provided.

Evolution Of Acute Ischemic Stroke Treatment As Supported By Clinical Trials, Savya S. Shukla, Brian F. Baigorri Md, Roberto I. Fourzali Md, Yafell Serulle Md

Radiology

No abstract provided.

Single Versus Multi-Center Surgeons' Risk-Adjusted Mitral Valve Repair Procedural Outcomes, Anne Bennett, Thomas Bogue, Samuel Greenberg, Joshua Zhu, Samantha Novotny, Joseph Pizzuti, Lee A. Santore, Robert H. Habib, Annie Laurie Laurie Shroyer, Jonathan Price, Henry Tannous, Thomas Bilfinger

Department of Surgery Faculty Publications

The purpose of this study is to explore strategies to improve mitral valve repair (MVr) outcomes. This research explores postoperative outcomes of patients undergoing MVr surgery by single center surgeons versus patients of multicenter surgeons. Specific outcomes of interest include 30-day operative mortality, major operative complications (e.g., deep sternal wound infection, permanent stroke, renal dysfunction requiring dialysis, reoperation, and prolonged ventilation), length of stay, and 30-day readmissions.

In brief, the serisk-adjusted outcome rates for surgeons that perform mitral valve repair procedures will be compared for surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC …

Maternal Characteristics And Outcomes Affected By Hypothyroidism During Pregnancy (Maternal Hypothyroidism On Pregnancy Outcomes, Mhpo-1), Zareen Kiran, Aisha Sheikh, Sarwar Malik, Areeba Meraj, Maha Masood, Safana Ismail, Owais Rashid, Quratulain Shaikh, Numan Majeed, Lumaan Sheikh, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period.
Methods: We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information …

Safety Of Endoscopy And Its Outcome In Pregnancy, Lubna Kamani, Muhammad S. Achakzai, Faisal Wasim Ismail, Farhana Kayani

Section of Gastroenterology

Objective: Gastrointestinal (GI) endoscopy is an important tool for diagnosis and treatment of GI diseases. However, when endoscopy is indicated during pregnancy, concerns about its safety for mother and fetus often arise. Our objective was to evaluate the safety and efficacy of endoscopic procedures in pregnant patients along with maternal and fetal outcomes.
Methods: This study was conducted at the Aga Khan University Hospital after Ethics review committee approval. It was a retrospective study and medical records of all pregnant patients who underwent endoscopy during pregnancy from January 2000 to January 2014 were analyzed. Data regarding the indications and type …

The Hiv Vaccine: Learning From Failure And Building On Success, Lindsey Mcclish, Kimberly Gathers, Katie Salay, Lisa Vranekovic, Kristin Seaman, Kelly M. Shields

Pharmacy and Wellness Review

An effective vaccine for acquired immune deficiency syndrome (AIDS) has eluded researchers since the identification of the HIV virus. There are many challenges in developing an effective HIV vaccine, including the lack of knowledge regarding the immune response to the virus and its diverse nature. Ethical concerns further complicate research. A recent phase III trial was performed in Thailand and showed that a significant reduction in HIV infection is possible. Pharmacists need to stay informed of these important breakthroughs in AIDS research in order to provide quality health information to patients in their community. This paper aims to evaluate the …

Implications And Concerns Regarding The Mammogram Debate, Kristen Quertinmont, Breanne Rizzo, Caitlin Swan, Mary E. Klein, Lindsay Coram, Whitney N. Detillion, Anne F. Gentry, Natalie Dipietro, Brenda Rizzo

Pharmacy and Wellness Review

Screening procedures that detect breast cancer in its early stages are an important element of preventative health care for all women. When official guidelines and recommendations for screening are modified, their changes impact health care at both the population and individual patient levels. Recently, the United States Preventive Service Task Force (USPSTF) has developed new recommendations regarding when to start mammogram screening for breast cancer in women of average risk for the development of breast cancer. This article discusses the rationale behind the updated USPSTF recommendations and also presents the current American Cancer Society (ACS) guidelines.

Role Of The Pharmacist In Improving Treatment For Children With Concurrent Gastrointestinal And Autism Spectrum Disorders, Whitney R. Henry, Kaitlin A. Sanders, Jenna L. Schaffner, Leslie M. Hart, Whitney N. Detillion, Anne F. Gentry

Pharmacy and Wellness Review

Over the last several years, a noteworthy association between gastrointestinal (GI) disorders and autism spectrum disorders (ASD) has been documented, although no large population-based studies exist. GI disorders in ASD children may stem from the underlying behavioral, communication, sensory or neurological issues intrinsic to the autistic disorder itself; therefore, the incorporation of alternative therapies, including behavioral modification, may be compelling treatment additions to the GI care traditionally recommended in children. To improve GI symptoms and quality of life in ASD children, a multidisciplinary approach is optimal, with pharmacists playing an active role in determining appropriate pharmacotherapy. Although there is a …

Options For Breast Cancer Prevention In High-Risk Patients, Ashley M. Overy, Lacey A. Shumate, Sarah M. Webb, Ashley E. Lehnert, Monica A. Weisenberger, Whitney N. Detillion, Andrew M. Roecker

Pharmacy and Wellness Review

Breast cancer is the most frequently diagnosed non-skin cancer in women, and one in eight women will develop breast cancer within their Iifetimes. Unfortunately, the strongest risk factors for breast cancer (i.e. age, family history, hormonal factors) are not easily modified. There is some evidence that chemopreventative drugs may be able to prevent breast cancer in high-risk patients. Tamoxifen and raloxifene have been shown to reduce the risk of breast cancer in high-risk women but may be associated with several serious adverse events. Clinical trials are currently in progress to determine if aromatase inhibitors are a viable alternative for breast …

A Review Of Dabigatran, An Oral Anticoagulant, Lindsey A. Hallman, Chad A. Rounds, Rebecca A. Carey, Nicole R. Hume, Karen L. Kier, James Spicer

Pharmacy and Wellness Review

Serious clinical complications associated with venous thrombotic embolism (VTE) necessitate prophylaxis in patient groups who are at high risk of VTE, specifically those recovering from orthopedic surgery with atrial fibrillation, with mechanical heart valves, at increased risk for stroke, or recovering post-MI. Currently, prophylaxis with warfarin, enoxaparin, or fondaparinux has been the standard of therapy, but these therapies each have their limitations. Dabigatran etexilate is an orally available pro-drug of dabigatran, a competitive, reversible, direct inhibitor thrombin (Factor lla). The agent is converted by esterases, and, thus, not associated with the complications of the CYP enzyme system. Dabigatran follows a …

The Black Identity, Hair Product Use, And Breast Cancer Scale, Dede Teteh, Marissa Ericson, Sabine Monice, Lenna Dawkins-Moultin, Nasim Bahadorani, Phyllis Clark, Eudora Mitchell, Lindsey S. Treviño, Adana Llanos, Rick Kittles, Susanne Montgomery

Health Sciences and Kinesiology Faculty Articles

Introduction
Across the African Diaspora, hair is synonymous with identity. As such, Black women use a variety of hair products, which often contain more endocrine-disrupting chemicals than products used by women of other races. An emerging body of research is linking chemicals in hair products to breast cancer, but there is no validated instrument that measures constructs related to hair, identity, and breast health. The objective of this study was to develop and validate the Black Identity, Hair Product Use, and Breast Cancer Scale (BHBS) in a diverse sample of Black women to measure the social and cultural constructs associated …

Image Restoration Using Automatic Damaged Regions Detection And Machine Learning-Based Inpainting Technique, Chloe Martin-King

Computational and Data Sciences (PhD) Dissertations

In this dissertation we propose two novel image restoration schemes. The first pertains to automatic detection of damaged regions in old photographs and digital images of cracked paintings. In cases when inpainting mask generation cannot be completely automatic, our detection algorithm facilitates precise mask creation, particularly useful for images containing damage that is tedious to annotate or difficult to geometrically define. The main contribution of this dissertation is the development and utilization of a new inpainting technique, region hiding, to repair a single image by training a convolutional neural network on various transformations of that image. Region hiding is also …

Secukinumab Efficacy On Resolution Of Enthesitis In Psoriatic Arthritis: Pooled Analysis Of Two Phase 3 Studies., Laura C Coates, Johan K Wallman, Dennis Mcgonagle, Georg A Schett, Iain B Mcinnes, Philip Mease, Lawrence Rasouliyan, Erhard Quebe-Fehling, Darren L Asquith, Andreas E R Fasth, Luminita Pricop, Corine Gaillez

Articles, Abstracts, and Reports

BACKGROUND: Enthesitis is one of the psoriatic arthritis (PsA) domains. Patients with enthesitis are associated with worse outcomes than those without enthesitis. The effect of secukinumab on the resolution of enthesitis in patients with PsA was explored using pooled data from the FUTURE 2 and 3 studies.

METHOD: Assessments of enthesitis through week 104 used the Leeds Enthesitis Index. These post hoc analyses included resolution of enthesitis count (EC = 0), median time to first resolution of enthesitis (Kaplan-Meϊer estimate), and shift analysis (as observed) of baseline EC (1, 2, or 3-6) to full resolution (FR), stable (similar or reduction …

Secukinumab Efficacy On Resolution Of Enthesitis In Psoriatic Arthritis: Pooled Analysis Of Two Phase 3 Studies., Laura C Coates, Johan K Wallman, Dennis Mcgonagle, Georg A Schett, Iain B Mcinnes, Philip Mease, Lawrence Rasouliyan, Erhard Quebe-Fehling, Darren L Asquith, Andreas E R Fasth, Luminita Pricop, Corine Gaillez

Articles, Abstracts, and Reports

BACKGROUND: Enthesitis is one of the psoriatic arthritis (PsA) domains. Patients with enthesitis are associated with worse outcomes than those without enthesitis. The effect of secukinumab on the resolution of enthesitis in patients with PsA was explored using pooled data from the FUTURE 2 and 3 studies.

METHOD: Assessments of enthesitis through week 104 used the Leeds Enthesitis Index. These post hoc analyses included resolution of enthesitis count (EC = 0), median time to first resolution of enthesitis (Kaplan-Meϊer estimate), and shift analysis (as observed) of baseline EC (1, 2, or 3-6) to full resolution (FR), stable (similar or reduction …

Update To The Vitamin C, Thiamine And Steroids In Sepsis (Victas) Protocol: Statistical Analysis Plan For A Prospective, Multicenter, Double-Blind, Adaptive Sample Size, Randomized, Placebo-Controlled, Clinical Trial., Christopher J. Lindsell, Anna Mcglothlin, Samuel Nwosu, Todd W. Rice, Alex Hall, Gordon R. Bernard, Laurence W. Busse, E. Wesley Ely, Alpha A. Fowler, David F. Gaieski, Jeremiah S. Hinson, Michael H. Hooper, James C. Jackson, Gabor D. Kelen, Mark Levine, Greg S. Martin, Richard E. Rothman, Jonathan E. Sevransky, Kert Viele, David W. Wright, David N. Hager

Department of Emergency Medicine Faculty Papers

BACKGROUND: Observational research suggests that combined therapy with Vitamin C, thiamine and hydrocortisone may reduce mortality in patients with septic shock.

METHODS AND DESIGN: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a multicenter, double-blind, adaptive sample size, randomized, placebo-controlled trial designed to test the efficacy of combination therapy with vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) given every 6 h for up to 16 doses in patients with respiratory or circulatory dysfunction (or both) resulting from sepsis. The primary outcome is ventilator- and vasopressor-free days with mortality as the key secondary outcome. …

Editorial: Sudden Unexpected Death In Epilepsy: Bio-Markers, Mechanisms, Risk Identification And Prevention., Rainer Surges, Michael R. Sperling, Christopher M. Degiorgio

Department of Neurology Faculty Papers

No abstract provided.

Increasing The Reinforcing Value Of Exercise In Overweight Adults, Kyle D. Flack, Kelsey Elise Ufholz, Luann Johnson, James N. Roemmich

Dietetics and Human Nutrition Faculty Publications

Objectives: This study determined whether a moderate- or high-dose exercise program increases exercise reinforcement. Increasing the relative reinforcing value of exercise (RRV_exercise; i.e., incentive sensitization of exercise) may increase the usual physical activity (PA) participation. Preference and/or tolerance for the intensity of exercise was also assessed.

Design: Sedentary men and women (body mass index, BMI: 25–35 kg/m²) were randomized into parallel exercise training groups expending either 300 (n = 18) or 600 (n = 18) kcal/exercise session, five sessions/week, for 12 weeks.

Methods: The RRV_exercise was determined by how much …

Emergent Airway Management Outside Of The Operating Room - A Retrospective Review Of Patient Characteristics, Complications And Icu Stay., Uzung Yoon, Jeffrey Mojica, Matthew Wiltshire, Kara Segna, Michael Block, Anthony Pantoja, Marc Torjman, Elizabeth Wolo

Department of Anesthesiology Faculty Papers

BACKGROUND: Emergent airway management outside of the operating room is a high-risk procedure. Limited data exists about the indication and physiologic state of the patient at the time of intubation, the location in which it occurs, or patient outcomes afterward.

METHODS: We retrospectively collected data on all emergent airway management interventions performed outside of the operating room over a 6-month period. Documentation included intubation performance, and intubation related complications and mortality. Additional information including demographics, ASA-classification, comorbidities, hospital-stay, ICU-stay, and 30-day in-hospital mortality was obtained.

RESULTS: 336 intubations were performed in 275 patients during the six-month period. The majority of …

A Case Of Ccdc6-Ret Fusion Mutation In Adult Acute Lymphoblastic Leukemia (All), A Known Activating Mutation Reported In All, Mateo Mejia Saldarriaga, Amir Steinberg, Eric A. Severson, Adam Binder

Department of Medical Oncology Faculty Papers

We report the case of a patient with B-Cell Acute Lymphoblastic Leukemia (ALL) who was found to harbor a gene fusion involving the CCDC6 and RET genes. Although the RET mutations have been identified before in othermalignancies, and it is thought to represent a driver mutation in these neoplasms, it has yet to be described in ALL. The identification of known fusion genes conferring activating tyrosine kinase activity in neoplasms can suggest potential therapeutic role of tyrosine kinase inhibitors (TKI), an approach that has been exploited in several other fusion genes.

Chronic Muscle Weakness And Mitochondrial Dysfunction In The Absence Of Sustained Atrophy In A Preclinical Sepsis Model, Allison M. Owen, Samir P. Patel, Jeffrey D. Smith, Beverly K. Balasuriya, Stephanie F. Mori, Gregory S. Hawk, Arnold J. Stromberg, Naohide Kuriyama, Masao Kaneki, Alexander G. Rabchevsky, Timothy A. Butterfield, Karyn A. Esser, Charlotte A. Peterson, Marlene E. Starr, Hiroshi Saito

Physiology Faculty Publications

Chronic critical illness is a global clinical issue affecting millions of sepsis survivors annually. Survivors report chronic skeletal muscle weakness and development of new functional limitations that persist for years. To delineate mechanisms of sepsis-induced chronic weakness, we first surpassed a critical barrier by establishing a murine model of sepsis with ICU-like interventions that allows for the study of survivors. We show that sepsis survivors have profound weakness for at least 1 month, even after recovery of muscle mass. Abnormal mitochondrial ultrastructure, impaired respiration and electron transport chain activities, and persistent protein oxidative damage were evident in the muscle of …

Alzheimer's And Amyloid Beta: Amyloidogenicity And Tauopathy Via Dyshomeostatic Interactions Of Amyloid Beta, Jordan Tillinghast

Senior Honors Theses

This paper reviews functions of Amyloid-β (Aβ) in healthy individuals compared to the consequences of aberrant Aβ in Alzheimer’s disease (AD). As extraneuronal Aβ accumulation and plaque formation are characteristics of AD, it is reasonable to infer a pivotal role for Aβ in AD pathogenesis. Establishing progress of the disease as well as the mechanism of neurodegeneration from AD have proven difficult (Selkoe, 1994). This thesis provides evidence suggesting the pathogenesis of AD is due to dysfunctional neuronal processes involving Aβ’s synaptic malfunction, abnormal interaction with tau, and disruption of neuronal homeostasis. Significant evidence demonstrates that AD symptoms are partially …