Medical Specialties Commons^™

Cultural Competency In Latinoamerican Countries: From A Hispanic Resident Perspective, Ivania T. Irby Md

Psychiatry

No abstract provided.

Surgical Stabilization Of Traumatic Flail Chest Is Superior To Conservative Management, Monique J. Cheng

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Marasco SF, Davies AR, Cooper J, et al. Prospective Randomized Controlled Trial of Operative Rib Fixation in Traumatic Flail Chest. Journal of the American College of Surgeons. 2013;216(5):924-932. doi: 10.1016/j.jamcollsurg.2012.12.024.

Nocardia Beijingensis: A Rare And Unusual Cause Of Intracranial Abscess, Lakshpaul Chauhan Md, Nirali Vassa Md, Elizabeth Henderson Md, Ateeq Mubarik Md, Danish M. Siddiq Md, Abdulmagid Eddib Md

Infectious Disease

Background : Nocardia species are thin, aerobic, filamentous, gram-positive bacilli that are ubiquitous in soil worldwide. Nocardia infections are divided into three main categories: pulmonary nocardiosis, disseminated nocardiosis, and cutaneous nocardiosis.

Methods : We present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB).

Results : A 60-year-old Caucasian lady from Florida with type 2 diabetes mellitus, hypertension, hyperlipidemia, presented to the emergency room with complaints of altered mentation. Per husband, she was having episodes of emesis and diarrhea three days prior to admission that resolved however, her mentation significantly deteriorated to where she was …

Improving Nicu Discharge Readiness Through Standardization Of Preparatory Practices, David Carola

Department of Pediatrics Posters

Global Aim

Critical transitions of care for every newborn will meet the Institute of Medicine STEEEPS criteria: Safe, Timely, Efficient, Effective, Equitable, Patient and Family Centered1, and Socially Responsible

SMART Aim

We aim to increase our average discharge readiness score by 4 points by August 1st of 2020

Somatic Symptom And Related Disorders: A Case Of Illness Anxiety Disorder In A Young Relatively Treatment Naive African American Male, Linda Zhang, Richard P. Leggett, Harrison Ross Galicki, William B. Dehart

Psychiatry

Somatic symptom and related disorders (including illness anxiety disorder and somatic symptom disorder) is a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) replacing somatoform and related disorders in the DSM-4 Text Revision. This classification eliminated the requirement that somatic symptoms must be nonorganic in nature, in an effort to reliably detect more cases of significant health anxiety than previously with DSM-4 criteria. Illness anxiety disorder is a primary anxiety disorder characterized by persistent preoccupation or excessive concern about having or developing an undiagnosed disease despite medical evaluation and reassurance. It is considered a …

Clinical, Cytogenetic, And Molecular Findings In Two Cases Of Variant T(8;21) Acute Myeloid Leukemia (Aml)., Lindsay Wilde, Jillian Cooper, Zi-Xuan Wang, Jinglan Liu

Department of Medical Oncology Faculty Papers

t(8;21)(q22;q22) is present in ~5–10% of patients with de novo acute myeloid leukemia (AML) and is associated with a better overall prognosis. Variants of the t(8;21) have been described in the literature, however, their clinical and prognostic significance has not been well-characterized. Molecular profiling of these cases has not previously been reported but may be useful in better defining the prognosis of this subset of patients. We present two cases of variant t(8;21) AML including clinical, cytogenetic, and molecular data.

Visualization And Quantification Of Post-Stroke Neural Connectivity And Neuroinflammation Using Serial Two-Photon Tomography In The Whole Mouse Brain, Katherine Poinsatte, Dene Betz, Vanessa O. Torres, Apoorva D. Ajay, Shazia Mirza, Uma M. Selvaraj, Erik J. Plautz, Xiangmei Kong, Sankalp Gokhale, Julian P. Meeks, Denise M. O. Ramirez, Mark P. Goldberg, Ann M. Stowe

Neurology Faculty Publications

Whole-brain volumetric microscopy techniques such as serial two-photon tomography (STPT) can provide detailed information on the roles of neuroinflammation and neuroplasticity throughout the whole brain post-stroke. STPT automatically generates high-resolution images of coronal sections of the entire mouse brain that can be readily visualized in three dimensions. We developed a pipeline for whole brain image analysis that includes supervised machine learning (pixel-wise random forest models via the “ilastik” software package) followed by registration to a standardized 3-D atlas of the adult mouse brain (Common Coordinate Framework v3.0; Allen Institute for Brain Science). These procedures allow the detection of cellular fluorescent …

Methicillin Resistant Staphylococcus Aureus Outbreak In A Neonatal Intensive Care Unit, Seema Irfan, Imran Ahmed, Farida Lalani, Naureen Anjum, Nadia Mohammad, Maria Owais, Afia Zafar

Department of Pathology and Laboratory Medicine

The global and national burden of communicable and noncommunicable diseases continues to rise, thus making access to Healthcare workers (HCWs) colonized with methicillin-resistant Staphylococcus aureus (MRSA) may pose transmission risk to vulnerable patients including neonates. This study reports an MRSA outbreak in a level-II neonatal intensive care unit (NICU) of a secondary care hospital in Pakistan. Once identified, an infection control team from the parent hospital visited the facility, risk factors were listed and infection control measures taken to control the outbreak. Screening cultures of NICU staff and environmental cultures from NICU were obtained for the presence of MRSA. Five …

Ecthyma Gangrenosum In An Immunocompromised Patient Without Detectable Bacteremia, Jonathan Miles, Alex Mari, Matthew Crabtree, Vinod Nambudiri, Jilian Sansbury

Dermatology

Ecthyma gangrenosum (EG) is typically pathognomonic of Pseudomonas aeruginosa bacteremia among immunocompromised patients, particularly with underlying malignancy. Recently, other pathogens and clinical histories have been implicated, challenging the classic picture of patients with EG. The cutaneous findings in patients follow a pattern of lesion progression from indurated pustules and hemorrhagic vesicles evolving to necrotic ulcers with central black eschar and surrounding erythema. While lesions typically occur on the perineum or lower extremities, their presence has also been described elsewhere. Herein, we describe a case of an immunocompromised man with chronic lymphocytic leukemia and multiple myeloma actively undergoing chemotherapy presenting with …

Changes In Body Mass Index And Atherosclerotic Disease Risk Score After Switching From Tenofovir Disoproxil Fumarate To Tenofovir Alafenamide., Jason J. Schafer, Kaitlin N. Sassa, Jaclyn R. O'Connor, Ayako Shimada, Scott W. Keith, Joseph A. Desimone

College of Pharmacy Faculty Papers

Background: Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF)-containing antiretroviral therapy (ART) can improve renal function and bone mineral density in people with human immunodeficiency virus (PWH). The switch can also negatively influence cholesterol, but changes in body mass index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk are unknown.

Methods: This retrospective observational study evaluated BMI and ASCVD risk score changes in virologically suppressed PWH who switched from TDF to TAF without switching other ART regimen components. Adults on TDF for ≥1 year with 2 consecutive HIV ribonucleic acid values/mL before a TAF switch were included. Body weight, …

Joint Annual Wellness Visit Scheduling, Rob Chamberlin, Jennifer Bliss, Andrea Lai, Paula Dougherty, Deb Swett, Logan Merrithew, Pam Stevens, Scott Williams

MaineHealth Maine Medical Center

Problem/Impact Statement: The pharmacists in Scarborough & Westbrook Primary Care conduct Medicare Annual Wellness Visits (AWVs) with a physician. The pharmacist and physician see the patient individually. The practices achieved and sustained FY18 Joint AWV volume goals through a new process to reschedule physician-only AWVs to Joints AWVs with a pharmacist. This leads to reschedule rework and reduced time practice staff have for patient care.

Patients Living With Hiv Infection Are Less Likely To Receive The Correct Statin Intensity For Cardiovascular Disease Risk Reduction, Jason J. Schafer, Pharmd, Mph, Roshni Emmons, Pharmd, Bcps, Nick V. Hastain, Pharmd, Todd Miano, Pharmd, Phd

College of Pharmacy Posters

• Patients living with HIV (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD)
• Eligible PLWH should receive statins for ASCVD risk reduction according to current guidelines
• Studies suggest that statins are underprescribed in PLWH, but comparisons to uninfected patients and assessments of statin intensity have not occurred

Objective

To determine the influence of HIV infection on appropriate statin prescribing for ASCVD risk reduction

Association Of Histologic Disease Activity With Progression Of Nonalcoholic Fatty Liver Disease., David E Kleiner, Elizabeth M Brunt, Laura A Wilson, Cynthia Behling, Cynthia Guy, Melissa Contos, Oscar Cummings, Matthew Yeh, Ryan Gill, Naga Chalasani, Brent A Neuschwander-Tetri, Anna Mae Diehl, Srinivasan Dasarathy, Norah Terrault, Kris V Kowdley, Rohit Loomba, Patricia Belt, James Tonascia, Joel E Lavine, Arun J Sanyal

Articles, Abstracts, and Reports

Importance: The histologic evolution of the full spectrum of nonalcoholic fatty liver disease (NAFLD) and factors associated with progression or regression remain to be definitively established.

Objective: To evaluate the histologic evolution of NAFLD and the factors associated with changes in disease severity over time.

Design, Setting, and Participants: A prospective cohort substudy from the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) NAFLD Database study, a noninterventional registry, was performed at 8 university medical research centers. Masked assessment of liver histologic specimens was performed, using a prespecified protocol to score individual biopsies. Participants included 446 adults with NAFLD enrolled in …

Potential Causes Of Early Death Among Admitted Newborns In A Rural Tanzanian Hospital, Robert Moshiro, Jeffrey M. Perlman, Paschal Mdoe, Hussein Kidanto, Jan Terje Kvaløy, Hege L. Ersdal

Obstetrics and Gynaecology, East Africa

Background: Approximately 40,000 newborns die each year in Tanzania. Regional differences in outcome are common. Reviewing current local data, as well as defining potential causal pathways leading to death are urgently needed, before targeted interventions can be implemented

Objective: To describe the clinical characteristics and potential causal pathways contributing to newborn death and determine the presumed causes of newborn mortality within seven days, in a rural hospital setting.

Methods: Prospective observational study of admitted newborns born October 2014–July 2017. Information about labour/delivery and newborn management/care were recorded on data collection forms. Causes of deaths were predominantly based on clinical diagnosis. …

Novel Sphingomyelin Biomarkers For Brain Glioma And Associated Regulation Research On The Pi3k/Akt Signaling Pathway, Xiao-Hui Zhai, Jian Xiao, Jie-Kai Yu, Hong Sun, Shu Zheng

Chemistry and Biochemistry Faculty Research

Glioma is one of the most common malignant tumor types of the central nervous system. It is necessary to identify biomarkers and novel therapeutic targets for glioma. The purpose of the present study was to distinguish lipid biomarkers with differential expression patterns in glioma tissues and normal brain tissues by matrix assisted laser desorption/ionization (MALDI)‑imaging and MALDI‑time of flight (TOF)‑mass spectrometry (MS). Additionally, identification of lipid biomarkers was performed to describe novel therapeutic targets for glioma treatment. A total of six tissues from three patients with glioma and three control patients with traumatic brain injury were analyzed using UltrafleXtreme MALDI‑TOF/TOF. …

Association Of Β-Amyloid Burden With Sleep Dysfunction And Cognitive Impairment In Elderly Individuals With Cognitive Disorders., Jason C. You, Erica Jones, Devon E. Cross, Abigail C. Lyon, Hyunseung Kang, Andrew B. Newberg, Carol F. Lippa

Department of Neurology Faculty Papers

Importance: Evidence shows that sleep dysfunction and β-amyloid (Aβ) deposition work synergistically to impair brain function in individuals with normal cognition, increasing the risk of developing dementia later in life. However, whether Aβ continues to play an integral role in sleep dysfunction after the onset of cognitive decline in individuals with dementia is unclear.

Objective: To determine whether Aβ deposition in the brain is associated with subjective measures of sleep quality and cognition in elderly individuals with cognitive disorders.

Design, Setting, and Participants: A nested survey study was conducted at the Cognitive Disorders and Comprehensive Alzheimer Disease Center of Thomas …

Validation Of A Miniaturized Permeability Assay Compatible With Crispr-Mediated Genome-Wide Screen., Claire Simonneau, Junning Yang, Xianguo Kong, Robert Kilker, Leonard Edelstein, Paolo Fortina, Eric R. Londin, Arie Horowitz

Cardeza Foundation for Hematologic Research

The impermeability of the luminal endothelial cell monolayer is crucial for the normal performance of the vascular and lymphatic systems. A key to this function is the integrity of the monolayer's intercellular junctions. The known repertoire of junction-regulating genes is incomplete. Current permeability assays are incompatible with high-throughput genome-wide screens that could identify these genes. To overcome these limitations, we designed a new permeability assay that consists of cell monolayers grown on ~150 μm microcarriers (MCs). Each MC functions as a miniature individual assay of permeability (MAP). We demonstrate that false-positive results can be minimized, and that MAP sensitivity to …

Effects Of Resistance Training On Depression And Cardiovascular Disease Risk In Black Men: Protocol For A Randomized Controlled Trial, Andrew M. Busch, Mark E. Louie, Micholas J. Santabarbara, Alex A. Ajayi, Neil Gleason, Shira I. Dunsiger, Michael P. Carey, Joseph T. Ciccolo

Faculty Authored Articles

Background

Depression is severely undertreated in Black men. This is primarily because Black men are less likely to seek traditional psychiatric treatment, have less access and more barriers to treatment, and perceive more stigma associated with treatment. Depression contributes to cardiovascular disease (CVD), and Black men have the highest rate of mortality from CVD. Resistance training (RT) can have beneficial effects on both depression and CVD. This study will be the first randomized controlled trial to test the effects of RT on depression and cardiovascular health in a sample of depressed Black men.

Method

Fifty Black men with clinically significant …

Use Of Integra For Reconstruction After Nevi Resection: A Systematic Review And Pooled Analysis Of Reported Cases, Jude Opoku-Agyeman, Kayla Humenansky, Wellington Davis Iii, Paul Glat

Plastic Surgery Resident Research

BACKGROUND:

The use of Integra Dermal Reconstruction Template has emerged as an option for wound reconstruction, after resection of congenital nevi, especially giant congenital nevi. There have been many reports on Integra use in the literature for this purpose. This systematic review with pooled analysis examines the current literature regarding Integra use after resection of congenital nevi, including patient characteristics and reported outcomes.

METHODS:

Systematic electronic searches were performed using PubMed, Ovid, Embase, and Cochrane library databases for studies reporting the use of Integra to reconstruct defects after nevi resection. Studies were analyzed if they met the inclusion criteria. Pooled …

Neurotransmitter, Fall 2019, George Washington Institute For Neuroscience Neurological Institute, George Washington University Hospital

Neurotransmitter

No abstract provided.

Evaluation Of Mitral Apparatus Blood Cyst: A Case Report And Review Of Literature, Dipesh Ludhwani, Belaal Sheikh, Yahya Sheikh

Publications and Research

Intracardiac blood cysts (ICBC) are cardiac pseudoneoplasm commonly seen in infants below two months of age. ICBC typically resolve spontaneously; however, they can sometimes persist in adults and can cause detrimental consequences. A 47-year-old female presented to our facility with complaints of chest pain and was found to have an incidental subvalvular chordal mitral apparatus echolucent mass on transthoracic echocardiogram (TTE). A stress echocardiography was performed, which revealed transient left ventricle outflow tract (LVOT) obstruction in the absence of anginal symptoms. A cardiac magnetic resonance imaging (MRI) showed no evidence of increased mass enhancement confirming the diagnosis of a benign …

A Quality Improvement Project To Determine The Incidence And Prevalence Of Obstructive Sleep Apnea, Best Practice Anesthesia Guidelines, And The Incidence Of Perioperative Cardiac And Respiratory Complications After The Implementation Of The Stop-Bang Questionnaire, Bradly Diamond, Gregory Guerrier, Cody Holliman, Robert Marrero, Tyler Nelson

Doctoral Projects

Patients with obstructive sleep apnea (OSA) are at risk for perioperative respiratory and cardiovascular compromise (Opperer et al., 2016). Unfortunately, almost 90% of patients with moderate-to-severe OSA are not diagnosed and unaware of their disorder; however, they remain at increased perioperative risks (Singh et al., 2015). The STOP-BANG questionnaire was developed to meet the need for a reliable, concise, and efficient screening tool for OSA risk. The facility at which this project was conducted did not utilize a prescreening OSA risk tool. The facility not using a prescreening OSA risk tool is especially important because the State of Mississippi currently …

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Developing A Local Anesthetic Systemic Toxicity Protocol In A Mississippi Hospital, James Dearman, Terry J. Tieman

Doctoral Projects

Local anesthetic systemic toxicity (LAST) is a rare complication of administering local anesthetic medications. However, this complication is potentially deadly, especially without prompt and correct treatment. Due to the rarity of LAST and the fact that its treatment differs from the conventional treatment of cardiac arrest, the authors sought a best practice recommendation to guide its treatment. While the most effective treatment for LAST has been well established, a thorough review of literature and survey of clinical preceptors demonstrated that most providers have not encountered LAST in clinical practice. Additionally, lipid emulsion therapy is a somewhat controversial treatment among some …

A Market Analysis Of Pay Rates For New Graduate Certified Registered Nurse Anesthetists, Zachary Halliwell

Doctoral Projects

The profession of Certified Registered Nurse Anesthetists (CRNA) is a thriving occupation. In their national Occupational Outlook Handbook, the Bureau of Labor Statistics (U.S. Department of Labor, 2018), reported the national market for CRNAs is predicted to continue its steady growth through 2026. The Bureau of Labor Statistics (BLS) provides numerous statistics, as previously mentioned, on their website. However, the stats available include CRNAs of varying experience levels. The Mississippi Department of Employment Security (MDES) has a few statistics, online, regarding the market for CRNAs. The data provided by MDES, while appreciated, is lacking in numerical significance, given the minuscule …

Oregon Region Standard Stroke Neurological Assessment Utilizing Aacn Synergy Model, Natalie Swearingen, Kailey Cox, Diane Clark

Articles, Abstracts, and Reports

No abstract provided.

Mortality Assessment Of Paclitaxel-Coated Balloons: Patient-Level Meta-Analysis Of The Illumenate Clinical Program At 3 Years., William A Gray, Michael R Jaff, Sahil A Parikh, Gary M Ansel, Marianne Brodmann, Prakash Krishnan, Mahmood K Razavi, Frank Vermassen, Thomas Zeller, Roseann White, Kenneth Ouriel, Mark A Adelman, Sean P Lyden

Articles, Abstracts, and Reports

BACKGROUND: A recent summary-level meta-analysis comprising randomized, controlled trials (RCTs) of femoropopliteal paclitaxel-coated balloon and stent intervention identified excess late mortality in the paclitaxel-treated patients.

METHODS: We evaluated the safety of the Stellarex drug-coated balloon (DCB) for femoropopliteal artery disease with an independently performed meta-analysis of patient-level data from all patients in the Stellarex femoropopliteal clinical program. To compare mortality after DCB or uncoated percutaneous transluminal angioplasty (PTA), we aggregated data from 2 RCTs comprising 419 patients treated with DCB and 170 patients treated with PTA. In an additional analysis, data were aggregated from 6 poolable Stellarex DCB studies (2 …

Molecular Characterization Of Multidrug-Resistance In Gram-Negative Bacteria From The Peshawar Teaching Hospital, Pakistan, A. Masseron, L. Poirel, B. Jamil Ali, M. A. Syed, P. Nordmann

Section of Pulmonary & Critical Care

Extended-spectrum β-lactamases, carbapenemases, 16S rRNA methylases conferring pan-drug aminoglycoside resistance and colistin resistance were investigated among Gram-negative bacteria recovered from clinical samples (infections) from 200 individuals hospitalized at the Khyber Teaching Hospital of Peshawar, north Pakistan, from December 2017 to March 2018. Out of 65 isolates recovered, 19% were carbapenem resistant and 16% carried a bla NDM-1 gene, confirming the widespread distribution of NDM producers in this country. The association of the NDM carbapenem-resistance determinant, together with the extended-spectrum β-lactamase CTX-M-15 and 16S rRNA methylases, was frequent, explaining the multidrug-resistance pattern observed. All isolates remained susceptible to colistin.

Hospitalization-Associated Change In Gait Speed And Risk Of Functional Limitations For Older Adults, Wei Duan-Porter, Tien N. Vo, Kristen Ullman, Lisa Langsetmo, Elsa S. Strotmeyer, Brent C. Taylor, Adam J. Santanasto, Peggy M. Cawthon, Anne B. Newman, Eleanor M. Simonsick, Teresa M. Waters, Kristine E. Ensrud

Health Management and Policy Faculty Publications

BACKGROUND: Hospitalization-associated functional decline is a common problem for older adults, but it is unclear how hospitalizations affect physical performance measures such as gait speed. We sought to determine hospitalization-associated change in gait speed and likelihood of new limitations in mobility and activities of daily living (ADLs).

METHODS: We used longitudinal data over 5 years from the Health, Aging and Body Composition Study, a prospective cohort of black and white community-dwelling men and women, aged 70-79 years, who had no limitations in mobility (difficulty walking 1/4 mile or climbing 10 steps) or ADLs (transferring, bathing, dressing, and eating) at baseline. …

Long-Term Safety And Efficacy Of Subcutaneous Pasireotide In Patients With Cushing's Disease: Interim Results From A Long-Term Real-World Evidence Study., Luca Manetti, Timo Deutschbein, Jochen Schopohl, Kevin C J Yuen, Michael Roughton, Ulrike Kriemler-Krahn, Libuse Tauchmanova, Ricardo Maamari, Carla Giordano

Articles, Abstracts, and Reports

PURPOSE: Clinical trials have demonstrated the favorable efficacy/safety profile of pasireotide in patients with Cushing's disease (CD). We report interim long-term results of an ongoing real-world evidence study of subcutaneous pasireotide in patients with CD.

METHODS: Adults with CD receiving pasireotide, initiated before (prior-use) or at study entry (new-use), were monitored for ≤ 3 years during a multicenter observational study ( http://clinicaltrials.gov identifier NCT02310269). Primary objective was to assess long-term safety of pasireotide alone or with other CD therapies.

RESULTS: At the time of this interim analysis, 127 patients had received pasireotide (new-use, n = 31; prior-use, n = 96). …