Medical Specialties Commons^™

Women And Children Living In Areas Of Armed Conflict In Africa: A Geospatial Analysis Of Mortality And Orphanhood, Zachary Wagner, Sam Heft-Neal, Paul H. Wise, Robert E. Black, Marshall Burke, Ties Boerma, Zulfiqar Ahmed Bhutta, Eran Bendavid

Department of Paediatrics and Child Health

Background:
The population effects of armed conflict on non-combatant vulnerable populations are incompletely understood. We aimed to study the effects of conflict on mortality among women of childbearing age (15–49 years) and on orphanhood among children younger than 15 years in Africa.
Methods:
We tested the extent to which mortality among women aged 15–49 years, and orphanhood among children younger than 15 years, increased in response to nearby armed conflict in Africa. Data on location, timing, and intensity of armed conflicts were obtained from the Uppsala Conflict Data Program, and data on the location, timing, and outcomes of women and …

Tilapia Consumption And Scombroid Poisoning., Ehizogie Edigin, Prasanth Lingamaneni, Juan Sarmiento, Hafeez Shaka, Sanjay A Patel

Ambulatory and Primary Care Articles

Scombroid poisoning, also known as histamine fish poisoning, typically occurs after eating dark meat fish. Higher levels of histidine, which is converted to histamine, causes anaphylaxis-like symptoms upon ingestion. There are few reported cases of scombroid in humans secondary to light meat fish. We present a case secondary to tilapia consumption.

Drug-Induced Autoimmune Hepatitis From Hydralazine Leading To Acute Liver Failure And Liver Transplantation, Jasleen Grewal, Angela Doan, Annie S. Hong, Arpit Amin, Jason V. Scapa, Ramy Hanna, Francisco Durazo, Beshoy Yanny

School of Medicine Faculty Research

We describe a woman with no previous liver disease who developed drug-induced autoimmune hepatitis from hydralazine prescribed to her for hypertension. Despite the discontinuation of the medication, she developed acute liver failure and subsequently underwent successful liver transplantation. She survived and had a good clinical outcome.

Immunoreactive Trypsinogen Levels In Newborn Screened Infants With An Inconclusive Diagnosis Of Cystic Fibrosis., Chee Y Ooi, Rosie Sutherland, Carlo Castellani, Katherine Keenan, Margaret Boland, Joe Reisman, Candice Bjornson, Mark A Chilvers, Richard Van Wylick, Steven Kent, April Price, Dimas Mateos-Corral, Daniel Hughes, Melinda Solomon, Peter Zuberbuhler, Janna Brusky, Peter R Durie, Felix Ratjen, Tanja Gonska

Paediatrics Publications

BACKGROUND:
Newborn screening (NBS) for cystic fibrosis (CF) not only identifies infants with a diagnosis of CF, but also those with an uncertain diagnosis of cystic fibrosis (CF), i.e. CF transmembrane conductance regulator (CFTR)-related metabolic syndrome (CRMS) or CF screen positive inconclusive diagnosis (CFSPID). These infants have an uncertain long-term outcome and it is currently unclear around time of diagnosis, which infants are at higher risk of later fulfilling a CF diagnosis. In this study, we hypothesised that immunoreactive trypsinogen (IRT) levels, used in NBS as a marker of pancreatic disease and function, may reflect the degree of CFTR dysfunction …

Peripheral Nerve Stimulator For Treating Nummular Headaches And Occipital Neuralgia, Bruce Dixon Do, Stephen Pyles Md, Ettore Crimi Md

Anesthesiology

No abstract provided.

Spinal Cord Stimulator For Treating Pudendal Neuralgia, Bruce Dixon Do, Stephen Pyles Md, Ettore Crimi Md

Anesthesiology

No abstract provided.

Perturbed Mitochondria-Er Contacts In Live Neurons That Model The Amyloid Pathology Of Alzheimer's Disease., Pamela V. Martino Adami, Zuzana Nichtova, David B. Weaver, Adam Bartok Dr., Thomas Wisniewski, Drew R. Jones, Sonia Do Carmo, Eduardo M. Castaño, A. Claudio Cuello, György Hajnóczky, Laura Morelli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The use of fixed fibroblasts from familial and sporadic Alzheimer's disease patients has previously indicated an upregulation of mitochondria-ER contacts (MERCs) as a hallmark of Alzheimer's disease. Despite its potential significance, the relevance of these results is limited because they were not extended to live neurons. Here we performed a dynamic in vivo analysis of MERCs in hippocampal neurons from McGill-R-Thy1-APP transgenic rats, a model of Alzheimer's disease-like amyloid pathology. Live FRET imaging of neurons from transgenic rats revealed perturbed 'lipid-MERCs' (gap width <10 nm), while 'Ca2+-MERCs' (10-20 nm gap width) were unchanged. In situ TEM showed no significant differences in the lipid-MERCs:total MERCs or lipid-MERCs:mitochondria ratios; however, the average length of lipid-MERCs was significantly decreased in neurons from transgenic rats as compared to controls. In accordance with FRET results, untargeted lipidomics showed significant decreases in levels of 12 lipids and bioenergetic analysis revealed respiratory dysfunction of mitochondria from transgenic rats. Thus, our results reveal changes in MERC structures coupled with impaired mitochondrial functions in Alzheimer's disease-related neurons.This article has an associated First Person interview with the first author of the paper.

Safety Climate, Safety Climate Strength, And Length Of Stay In The Nicu, Daniel S Tawfik, Eric J Thomas, Timothy J Vogus, Jessica B Liu, Paul J Sharek, Courtney C Nisbet, Henry C Lee, J Bryan Sexton, Jochen Profit

Faculty, Staff and Student Publications

BACKGROUND: Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs).

METHODS: Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU's respondents, i.e., safety climate strength, was determined via intra-unit standard deviation …

Opioid And Non-Opioid Prescribing Rates For Ankle Fractures In Emergency Departments Across The United States Between 2006 And 2015, Lucy C. Bowers, Kyle B. Kosik Phd, Atc, Matt C. Hoch Phd, Atc, Phillip A. Gribble Phd, Atc, Alejandro G. Villasante Tezanos

Posters-at-the-Capitol

Context: An ankle fracture is a common injury observed in the Emergency Department (ED) and is often treated conservatively or surgically, depending on whether the fracture is stable. Opioids provide value for the management of acute musculoskeletal pain. However, prolong opioid use is associated with well-known consequences in the United States such as dependence, abuse and/or misuse. Considering these concerns and the effectiveness of non-pharmacological interventions for the treatment of acute pain, it is critical to identify the prescribing patterns for patients diagnosed with an ankle fracture in the ED. Objective: Describe the percentage of patients prescribed a …

The Role Of The Pharmacy Team In Atrial Fibrillation Detection In Nonclinical Settings, Brian C. Hazelrigg, Monica L. Miller, Sotiris Antoniou, Jagjot Chahal, Sadeer Fhadil

Purdue Journal of Service-Learning and International Engagement

Atrial Fibrillation (AF) is a common cardiac/heart disease that increases a person’s risk of death, making early identification significant in overall disease management. Throughout my time in pharmacy school, I [Brian] have developed an interest in cardiology and research. During my last year of pharmacy school, I spent eight weeks at St. Bartholomew’s Hospital, in London, England, one of the largest cardiac centers within Europe, on an experiential training experience. While there, I had the opportunity to study specifics about many cardiac illnesses, with a focus on atrial fibrillation, and provide education to patients living with this disease. In addition …

Metformin And Cancer: Pharmacoepidemiology Considerations, Sarah Kradel, Christina Spinaris, Victoria Pennington, Adam Trimble, Lara Long, Natalie Dipietro

Pharmacy and Wellness Review

No abstract provided.

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

Pharmacy and Wellness Review

No abstract provided.

The Role Of The Pharmacist In Patient-Centered Medical Homes, Eric Stack, Kevin Stack, Stelios Theophanous, Karen L. Kier

Pharmacy and Wellness Review

No abstract provided.

Maternal Characteristics Affect Fetal Growth Response In The Women First Preconception Nutrition Trial., K Michael Hambidge, Carla M Bann, Elizabeth M Mcclure, Jamie E Westcott, Ana Garcés, Lester Figueroa, Shivaprasad S Goudar, Sangappa M Dhaded, Omrana Pasha, Sumera A Ali, Richard J Derman, Robert L Goldenberg, Marion Koso-Thomas, Manjunath S Somannavar, Veena Herekar, Umber Khan, Nancy F Krebs

Global Health Articles

The objective of this secondary analysis was to identify maternal characteristics that modified the effect of maternal supplements on newborn size. Participants included 1465 maternal-newborn dyads in Guatemala, India, and Pakistan. Supplementation commenced before conception (Arm 1) or late 1st trimester (Arm 2); Arm 3 received usual care. Characteristics included body mass index (BMI), stature, anemia, age, education, socio-economic status (SES), parity, and newborn sex. Newborn outcomes were z-scores for length (LAZ), weight (WAZ), and weight to length ratio-for-age (WLRAZ). Mixed-effect regression models included treatment arm, effect modifier, and arm * effect modifier interaction as predictors, controlling for site, …

A Case Of Cannot Intubate, Cannot Ventilate, Evan Davidson Md, Su Min Oon

Anesthesiology

69M with a PMH of parotid gland carcinoma status post resection and radiation therapy with extensive reconstruction, G-tube placement, COPD, multiple tracheostomies with takedowns (with refusal permanent tracheostomy over objections of family members) presented for CTR and ulnar tunnel exploration. With plans of MAC, an axillary block was placed and maintained on minimal propofol infusion. After administration of 50 mcg fentanyl due to pain, he was noted to be apnic. Ventilation via mask and #3 LMA failed, as well as placement of an 6 mm ET tube. Eventually, patient was ventilated via emergency surgical cricothyroidotomy. He was discharged on POD4.

Management Of Incidental Aortic Mural Thrombus In The Setting Of Heparin-Induced Thrombocytopenia, Mal P. Homan Do, Brian J. Holahan Do, Soorya N. Aggarwal Do, Robert V. Decker Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Anti-Synthetase Syndrome Presenting As Rapidly Progressive Interstitial Lung Disease, Nathan Brewster Do, Amogh M. Joshi Do, Alaynna C. Kears Do, Kareem Godil Md, Jessica Boehmler Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Pleural Effusion With Trapped Lung Associated With Methimazole Induced Hypothyroidism, Nathan Brewster Do, Michal Kloska Md, Alaynna C. Kears Do, Brian J. Holahan Do, Waqas Adeel Md

Department of Medicine

No abstract provided.

Intraabdominal Fire During Emergency Laparotomy, Heather Christopherson Md, Alan Kroll Md

Anesthesiology

72 yo obese male presented to ED for 2 day history abdominal pain: sharp, radiating bilateral upper quadrants, n/v/constipation. Patient took entire bottle magnesium citrate, pain became unbearable. On arrival SaO2 88% RA, other vitals stable, Lactic Acid 1.85 mg/dl, CT abdomen massive free air. Taken to OR, intubated, general anesthesia, peritoneal cavity entered with cautery device. Upon entering peritoneum abdomen, flames erupted from the cavity. Flames spontaneously extinguished. No thermal injury sustained by patient. Surgeon’s eyebrows where singed, no other injuries sustained by OR staff. Patient remained hemodynamically stable, surgery proceeded without incident.

Fostering Productive Conversations In A Kenyan Tertiary Intensive Care Unit: Lessons Learnt, Sayed Karar, Jamila Nambafu, Feroza Daroowalla

Internal Medicine, East Africa

Effective communication remains key in delivery of comprehensive care to patient especially in the intensive care unit (ICU) setting. However, many providers, for various reasons, struggle with the art of effective communication adversely affecting relationship with patients and their families. Little is known or has been published about effective communication in ICUs within sub-Saharan Africa.

Flare Of Rheumatoid Arthritis Associated Interstitial Lung Disease Secondary To Lung Biopsy, Nathan Brewster Do, Breanna S. Goldner Do, Kareem Godil Md, Ethan S. Stern Do, Jessica Boehmler Md

Department of Medicine

No abstract provided.

Concurrent Catastrophic Antiphospholipid Syndrome And Heparin-Induced Thrombocytopenia, Brian J. Holahan Do, Kareem Godil Md, Nathan Brewster Do, Jonaid Aslam Md

Department of Medicine

No abstract provided.

Implications Of Frailty In Copd Exacerbations, Aimee Almanzar, Armando Cabrera, Felix Hernandez, Hector Y. Vazquez, Asma Jafri, Miriam Zylberglait Lisigurski, Livasky Concepcion, Gustavo Ferrer

Pulmonary Disease

Introduction The extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) patients are similar to symptoms of frailty, a geriatric syndrome. This study was designed to identify the relation between frailty and patient outcomes during a COPD exacerbation. Methods This retrospective study identified 10,235 patients hospitalized for COPD exacerbation, as well as 16 laboratory tests included in a frailty index that have been linked to frailty. Patients were divided into less frail (0-8 positive laboratory values) and more frail (9-16 positive laboratory values) groups. The primary composite endpoints were mechanical ventilation, ICU length of stay, readmission, and discharge status. Results Of …

Does Perioperative Use Of Renin-Angiotensin System Inhibitors Improve Patient Outcomes In Cardiac Surgery?, Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, Jianzhong Sun

Department of Anesthesiology Posters

• 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
• 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
• Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
• There is still a lack of large clinical …

Anesthetic Management Without The Use Of Neuromuscular Blocking Agents In Myasthenia Gravis Patient Undergoing Coronary Artery Bypass Grafting And Thymectomy, Katarina Kapisoda, Ettore Crimi Md, Omeni Osian

Anesthesiology

We describe a novel and effective anesthetic management of a 67 year old male with myasthenia gravis (MG) who underwent combined coronary artery bypass graft and thymectomy. Induction of general anesthesia with endotracheal intubation was performed with propofol and remifentanyl without use of any neuromuscular blocking agents (NMBA). General anesthesia was then maintained with inhaled isoflurane and continuous intravenous infusion of sufentanyl and dexmedetomidine. In ICU, trachea was extubated within two hours from admission and no complications occurred during the following 24 hours ICU stay. Avoidance of NMBA may improve outcomes by decreasing the risks associated with their use.

Just Another Labor Epidural, Whitney King Do, William B. Smith

Anesthesiology

A 32 year-old healthy pregnant patient with no significant past medical history who presented to the hospital for delivery of fetus status post intrauterine fetal death. Vaginal delivery with epidural placement was initially the mother’s preference. Fetal movement last felt 4 days prior. The patients H&P and laboratory findings revealed early stages DIC. Patient underwent Caesarean delivery with general anesthesia, the OB physician found the patient to have Couvelaire uterus, a form of placental abruption. The patient’s uterus was atonic requiring multiple units of blood products. Case assessed indications for epidural placement versus general anesthesia.

Clinician Evaluators: Take Your Mark!, Jodi Polaha, William Lusenhop, Mckenzie Highsmith, Deepu George, Adrian Sandoval

ETSU Faculty Works

• Discuss two implementation outcomes (adoption and reach) and explain why they are important for clinicians to measure and report, with application to own work.
• Name sources of data that are accessible to clinicians in health care settings, with consideration of own setting.
• Describe a range of dissemination strategies used to create impact, including new ideas for dissemination of own work.

References

• Proctor, E. K., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G. A., Bunger, A., . . . Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental …

Rash Provokes Catastrophic Antiphospholid Syndrome, Alaynna C. Kears Do, Nathan Brewster Do, Breanna S. Goldner Do, Kareem Godil Md, Aaron J. Czysz Md

Department of Medicine

No abstract provided.

Severe Bradycardia During A Spinal Cord Stimulator Procedure, Marc Blanchard Md, Ettore Crimi Md, Stephen Pyles Md

Anesthesiology

We report a case of severe bradycardia during spinal cord implantation. A 43 year old female with a history of chronic refractory lumbar back pain presented for revision of spinal cord stimulator. Preoperative assessment was positive only for bilateral lower extremity radiculopathy. During the procedure, surgeon’s attempt to advance the lead through scar tissue elicited severe bradycardia (HR 28) resolved with glycopyrrolate. Compression of spinal cord secondary to difficult lead placement could be the cause of this cardiovascular event. Anesthesiologists need to be aware that severe bradycardia can occur during spinal cord implantation.

Rapidly Progressive Rheumatoid Lung Disease, Alaynna C. Kears Do, Nathan Brewster Do, Andrea M. Soliman Do, Stacey Smith Md, Facp, James Ross Md, Facp

Department of Medicine

No abstract provided.