Medical Specialties Commons^™

Case Report: Tocilizumab For The Treatment Of Sars-Cov-2 Infection In A Patient With Aplastic Anemia, Gina Keiffer, Zach French, Lindsay Wilde, Joanne Filicko-O'Hara, Usama Gergis, Adam Binder

Department of Medicine Faculty Papers

While cytokine storm develops in a minority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, novel treatment approaches are desperately needed for those in whom it does. Tocilizumab, an interleukin-6 receptor antibody, has been utilized for the treatment of cytokine storm in a number of severe inflammatory conditions, including in patients with severe coronavirus disease 2019 (COVID-19). Here, we present the first published case utilizing this therapy in a patient with underlying immunodeficiency. Our patient with aplastic anemia developed cytokine storm due to COVID-19 manifested by fever, severe hypoxia, pulmonary infiltrates, and elevated inflammatory markers. Following treatment …

Pain In The Prehospital Setting In Rwanda: Results Of A Mixed-Methods Quality Improvement Project., A Rosenberg, E Uwitonze, M Dworkin, J P D Guidry, T Cyuzuzo, D Banerjee, K Mcintyre, K Carlyle, J M Uwitonze, I Kabagema, T Dushime, S Jayaraman

Student Papers, Posters & Projects

Introduction: Pain is a universal human experience tied to an individual's health but difficult to understand. It is especially important in health emergencies. We performed a two-step quality improvement project to assess pain management by the SAMU ambulance service in Kigali, Rwanda, examining how pain is assessed and treated by ambulance staff to facilitate development of standardized guidelines of pain management in the prehospital setting, which did not exist at the time of the study.

Materials and Methods: Deidentified ambulance service records from December 2012 to May 2016 were analyzed descriptively for patient demographics, emergency conditions, pain assessment, and medications …

Intratumoral Translocation Positive Heterogeneity In Pediatric Alveolar Rhabdomyosarcoma Tumors Correlates To Patient Survival Prognosis, Katrina Gleditsch, Jorge Peñas, Danielle Mercer, Ayesha Umrigar, James Briscoe, Matthew Stark, Fern Tsien, Andrew D. Hollenbach

School of Medicine Faculty Publications

Alveolar rhabdomyosarcoma (ARMS) is characterized by one of three translocation states: t(2;13) (q35;q14) producing PAX3-FOXO1, t(1;13) (p36;q14) producing PAX7-FOXO1, or translocation-negative. Tumors with t(2;13) are associated with greater disease severity and mortality than t(1;13) positive or translocation negative patients. Consistent with this fact, previous work concluded that a molecular analysis of RMS translocation status is essential for the accurate determination of prognosis and diagnosis. However, despite this knowledge, most diagnoses rely on histology and in some cases utilize fluorescence in situ hybridization (FISH) probes unable to differentiate between translocation products. Along these same lines, diagnostic RT-PCR analysis, which can differentiate …

Linguistic Analysis Of Empathy In Medical School Admission Essays, Mary Yaden, David Yaden, Anneke Buffone, Johannes Eichstaedt, Patrick Crutchley, Laura Smith, Jonathan Cass, Clara Callahan, Susan Rosenthal, Lyle Ungar, Andrew Schwartz, Mohammadreza Hojat

Department of Psychiatry and Human Behavior Faculty Papers

Objectives: This study aimed to determine whether words used in medical school admissions essays can predict physician empathy.

Methods: A computational form of linguistic analysis was used for the content analysis of medical school admissions essays. Words in medical school admissions essays were computationally grouped into 20 'topics' which were then correlated with scores on the Jefferson Scale of Empathy. The study sample included 1,805 matriculants (between 2008-2015) at a single medical college in the North East of the United States who wrote an admissions essay and completed the Jefferson Scale of Empathy at matriculation.

Results: After correcting for multiple …

Characterization Of The Intraarticular Cytokine Response In Children With Septic Arthritis, Walter Dehority, Kathryn Helmig, Scott Plaster, Nathan Huff, Andrew Parsons, Selina Silva

2020 Pediatric Research Forum Session

Background:

Acute septic arthritis (ASA) is the most common pediatric orthopaedic infection, and may be associated with severe sequelae. An improved understanding of the intra-articular inflammatory response in ASA may facilitate the use of immunomodulatory agents to attenuate the deleterious effects of the host immunological response on synovial tissue, help monitor disease progression and differentiate ASA from non-infectious arthritides. To our knowledge, no study has characterized the intra-articular cytokine response in children with ASA in detail. Given this, we attempted to validate a multi-plex cytokine assay for use in the blood and synovial fluid of children with ASA.

Methods:

Twelve …

Effects Of Race/Ethnicity On Appendicitis Pain Management, Alfonso Belmonte, Christal Chow, Maria Heubeck, Deirdre Hill, Harry Snow

2020 Pediatric Research Forum Session

Background:

Race is a well-researched factor that contributes to variation in care of multiple diagnoses such as asthma, antibiotic prescribing, and pain control. This is also true for appendicitis. As the 6th most common cause for inpatient stay, it costs on average of $7,800 per patient. Despite efforts to standardize care, race and ethnicity continue to play a role in treatment and outcomes on pediatric appendicitis.

We hope to further explore the effects that race/ethnicity have in medical care, diagnosis and complications of acute pediatric appendicitis. We hope that identifying these effects will help providers to actively address race/ethnic health …

E. Behavioral Evaluation And Addiction Management (Beam) Team, Deanne Niedziela

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

Cinematic Portrayal Of Infectious Disease Outbreaks, Walter Dehority

2020 Pediatric Research Forum Session

Background:

Movies are a shared cultural experience. Films likely reflect societal fears, and may provide insight into how the public perceives infectious disease outbreaks.

Methods:

A search of IMDb.com was conducted in February/March 2020 (updating a 2017 search) using 163 infection-related search terms to identify films with an emphasis on infectious diseases (as assessed by review of plot synopses on IMDb, the American Film Institute database, or Wikipedia) through December 31, 2019. Films featuring an outbreak or pandemic (as defined by the CDC, with the outbreak/pandemic required to be an important component of the story) were then selected. Cultural relevance …

Pathogen-Specific Neurocognitive Outcomes In Tropical Childhood Encephalitis, Christal Chow, Ashan Jayawickrama, Jithangi Wanigasinghe, Piyadasa Kodituwakku, Kurt Schwalm, Darrell Dinwiddie, John Phillips, Walter Dehority

2020 Pediatric Research Forum Session

Background:

Childhood encephalitis causes long-term neurocognitive disability, which may lead to secondary disabilities such as poor academic achievement and social isolation. This is particularly problematic in resource limited, tropical countries, where the burden of vector-borne viral encephalitis is substantial, yet the resources for identifying the myriad of pathogens involved and characterizing the resulting neurocognitive sequelae are limited. To our knowledge, comprehensive assessments of neurocognitive function following tropical childhood encephalitis have not been performed. We hypothesize that the risk of neurocognitive sequelae is pathogen-specific, and that the use of portable, on-site metagenomic Next Generation Sequencing of CSF in Sri Lankan children …

J. Diet Advancement For Cesarean Section Patients In Postpartum Unit, Fereshteh Pirayesh, Joan Gahan, Ari Meyers

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

C. Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Smell & Taste), Marietta Sperry, Kimberly Kohlieber

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

A. Keynote: Broadcasting Stress In The Covid-19 Pandemic: Media, Collective Trauma, & Well-Being, E. Alison Holman (Invited Keynote Speaker)

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

K. Use Of A Standardized Procedure To Improve Care For Behavioral Health Patients, Elizabeth Winokur

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

B. The Effects Of The Safety Zone Process On Perception Of Safety, Workflow, Wellbeing And Teamwork When Caring For Covid-19 Patients, Claudia Skinner

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

Renal Proximal Tubular Nemo Plays A Critical Role In Ischemic Acute Kidney Injury, Sang Jun Han, Ryan M. Williams, Mihwa Kim, Daniel A. Heller, Vivette D'Agati, Marc Schmidt-Supprian, H. Thomas Lee

Publications and Research

We determined that renal proximal tubular (PT) NF-κB essential modulator (NEMO) plays a direct and critical role in ischemic acute kidney injury (AKI) using mice lacking renal PT NEMO and by targeted renal PT NEMO inhibition with mesoscale nanoparticle–encapsulated NEMO binding peptide (NBP MNP). We subjected renal PT NEMO–deficient mice, WT mice, and C57BL/6 mice to sham surgery or 30 minutes of renal ischemia and reperfusion (IR). C57BL/6 mice received NBP MNP or empty MNP before renal IR injury. Mice treated with NBP MNP and mice deficient in renal PT NEMO were protected against ischemic AKI, having decreased renal tubular …

Ambivalence In How To Address Adolescent Marijuana Use Among School-Based Health Center Providers, Rachel A. Sebastian, Lara M. Gunderson, Cathleen E. Willging, Mary M. Ramos

2020 Pediatric Research Forum Session

Objective:

As part of a larger study to evaluate the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) at school-based health centers (SBHCs), we interviewed SBHC providers regarding their perceptions of substance use among adolescents seen at their SBHCs, experiences providing care for students with substance use and other mental health issues, and their concerns around marijuana specifically.

Methods:

We interviewed 12 primary and behavioral health providers who worked at five SBHCs in New Mexico. The interviews lasted approximately 1 hour and were digitally recorded and professionally transcribed. Two research team members independently analyzed the transcripts. We undertook …

An Institutional Experience With Emicizumab In Pediatric Patients With Heophilia A, Shirley Abraham, Lisa Jung, Janet Ratte, Valerie Lowe

2020 Pediatric Research Forum Session

Background: Emicizumab is a recombinant, humanized, bispecific monoclonal antibody that substitutes for the function of FVIII by binding to activated factor IX and X. It is currently indicated for routine prophylaxis in adults and children of all ages with hemophilia A, with or without inhibitors. Despite basic guidelines provided by MASAC and the drug package insert, there is significant inter-institutional variability regarding monitoring and follow up in patients on emicizumab.

Objective: To outline our institutional experience in pediatric patients on emicizumab.

Method: Retrospective and prospective chart review of our patients on emicizumab. Information collected included age of patient, hemophilia severity, …

Increased Incidence Of Asthma In Children With Prenatal Opioid Exposure, Isabella Cervantes, Shikhar Shrestha, Sharon Ruyak, Jessie R. Maxwell

2020 Pediatric Research Forum Session

Prenatal opioid exposure (POE) has increased dramatically in the last 10 years, with nearly 100 babies born daily in the United States with Neonatal Opioid Withdrawal Syndrome (NOWS). The impact on long-term outcomes continues to be investigated. Given the proinflammatory state that results from POE, we hypothesized that infants with POE or NOWS diagnoses during the newborn hospitalization would have an altered immune reactivity that persisted into childhood, defined by asthma diagnosis within the first 8 years.

A retrospective cohort design utilizing a comprehensive CERNER HealthFacts U.S. national database was completed, which accesses clinical data from 800 hospitals across the …

A Technical Assistance Model To Facilitate Use Of The School Health Index To Assess Chronic Health Condition Management In Schools, Grace L. Mccauley, Sarah Sanders, Anne Marlow-Geter, Elizabeth Yakes Jimenez

2020 Pediatric Research Forum Session

Introduction:

Chronic health conditions, such as asthma and food allergies, affect a substantial proportion of school-aged children in New Mexico (NM). School health services, policies, programs, and practices can affect daily management of chronic pediatric health conditions. The Center for Disease Control and Prevention’s School Health Index (SHI) is a self-assessment and planning guide that evaluates school services, policies, and programs for promoting health and safety. Our aim was to determine if a technical assistance (TA) model could effectively support school districts in using the SHI to complete a chronic disease needs assessment (CDNA).

Methods:

Seven public and one charter …

Comparison Of Virulence Gene Carriage In Staphylococcus Aureus Isolates Colonizing Human Skin And Those Associated With Soft Tissue Osteoarticular Infections, Kylie Disch, Jon Femling, Parisa Mortaji, Kurt Schwalm, Aimee Yousey, Rebekkah Varjabedian, Darrell Dinwiddie, Walter Dehority

2020 Pediatric Research Forum Session

Background:

Osteoarticular infections (OAI), most commonly caused by S. aureus, cause extreme morbidity in children and may result in permanent sequelae (e.g. limb-length discrepancies). However, S. aureus is also a common colonizing bacteria of skin and a cause of soft tissue abscesses. Virulence determinants for S. aureus are likely complex, and may include the genetic composition of the isolate, the host immune response and the transcriptomic profile of the organism. A necessary first-step in characterizing these virulence factors includes assessing virulence gene carriage between S. aureus isolates from children with OAIs and from less virulent isolates.

Methods:

S. aureus …

Baseline Results From The Strategic Implementation Of Screening, Brief Intervention And Referral To Treatment (Sbirt) In School‐Based Health Centers Initiative, Grace Mccauley, Timothy Ozechowski, Julia Martinez, Elizabeth Yakes Jimenez, Mary M. Ramos

2020 Pediatric Research Forum Session

Introduction:

The rates of substance use among teens in NM are among the highest in the US. Regular use of illicit drugs during adolescence can compromise mental and physical health and contribute to poorer longer-term outcomes. The Strategic Implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT) in School‐Based Health Centers (SBHCs) [SISS] initiative implements and evaluates the SBIRT model, with a goal of identifying, reducing, and preventing substance use in New Mexico (NM) adolescents. For this analysis, we describe baseline data on the provision of SBIRT to adolescents at‐risk for substance abuse.

Methods:

From October to December 2019, …

The Window Ductus, A Rare Finding, And The Importance Of Perinatal Echocardiography, Storm Dorrough, Gavin Mccullough, Michelle Grenier

2020 Pediatric Research Forum Session

Category: Case Report

We present a case of an unusual form of the ductus arteriosus termed “window ductus,” and highlight the importance of early recognition echocardiogram. The patient presented as a 22 week fetus due to advanced maternal age, maternal cardiomyopathy, and an abnormal 4-chamber view on the fetal anatomy ultrasound. Fetal images were consistent with polyvalvular disease with redundancy of the mitral, tricuspid and aortic valves. There was an extremely abnormal pulmonic valve that was thickened, stenotic, and regurgitant due to relative immobility of the cusps, creating a narrow, tunnel-like orifice and post-stenotic dilated main pulmonary artery. The right …

Microglial-Associated Responses To Comorbid Amyloid Pathology And Hyperhomocysteinemia In An Aged Knock-In Mouse Model Of Alzheimer's Disease, David J. Braun, Edgardo R. Dimayuga, Josh M. Morganti, Linda J. Van Eldik

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: Elevated blood homocysteine levels, termed hyperhomocysteinemia (HHcy), is a prevalent risk factor for Alzheimer's disease (AD) in elderly populations. While dietary supplementation of B-vitamins is a generally effective method to lower homocysteine levels, there is little if any benefit to cognition. In the context of amyloid pathology, dietary-induced HHcy is known to enhance amyloid deposition and certain inflammatory responses. Little is known, however, about whether there is a more specific effect on microglia resulting from combined amyloid and HHcy pathologies.

METHODS: The present study used a knock-in mouse model of amyloidosis, aged to 12 months, given 8 weeks of …

Prenatal Alcohol Exposure And Placental Insufficiency Results In Reduced Neuronal Complexity In The Rat Prefrontal Cortex, Nathaniel Pavlik, Jessie Newville, Clement P. Jose, Suzy Davies, Jennifer Wagner, Jonathan Brigman, Daniel Savage, Jessie R. Maxwell

2020 Pediatric Research Forum Session

Prenatal Alcohol Exposure (PAE) can produce long-term neurodevelopmental deficits and impaired executive function. Alcohol exposure during gestation is associated with impaired fetal development caused by placental insufficiency. The impact following PAE and placental insufficiency (PI) remains unknown. Utilizing a three-dimensional (3D) Sholl analysis, we hypothesized that PAE+PI will result in decreased neuronal complexity within the frontal cortex, a region critical to executive functioning.

Pregnant Long-Evans rats voluntarily drank 5% ethanol or saccharin water until embryonic day 18 (E18) to mimic moderate PAE. On E19, a laparotomy was performed to occlude the uterine artery for 60 minutes to induce PI. The …

Operability, Usefulness, And Task-Technology Fit Of An Mhealth App For Delivering Primary Health Care Services By Community Health Workers In Underserved Areas Of Pakistan And Afghanistan: Qualitative Study, Shehla Zaidi, Abdul Momin Kazi, Atif Riaz, Ammarah Ali, Rabia Najmi Taha, Rawshan Jabeen, Umerdad Khudadad, Saleem Sayani

Community Health Sciences

Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan.
Objective: Our study aimed to explore CHW perceptions on the operability …

Localized Intravascular Coagulopathy Of Venous Malformation Involving The Labia As A Mimic Of Child Sexual Abuse: A Case Report, Leslie Strickler, Lan Anh Van-Dinh, Christopher Torrez, Jessica Williams

2020 Pediatric Research Forum Session

Given location and relative rarity, ano-genital injuries in children often prompt concern for maltreatment. We present a case of localized intravascular coagulopathy as a complication of venous malformation, which mimicked abusive trauma leading to an evaluation for maltreatment. Comprehensive assessment identified the underlying medical cause. This case represents an example of the importance of objective assessment in unusual case presentations to ensure diagnostic accuracy, and appropriate direction of medical and child protection resources.

Lamotrigine Overdose Presenting As Shock And Pulmonary Edema, Savannah P. Ellenwood, John A. Mason, Nathaniel E. Link, Robert C. Hellinga, Natasha C. James, Anjali V. Subbaswamy

2020 Pediatric Research Forum Session

Abstract:

Lamotrigine is a broad-spectrum anti-epileptic drug with a good safety profile used to treat general and focal epilepsy. Toxicity is uncommon and usually mild, and symptoms usually include rash, headache, nausea, abdominal pain, somnolence, dizziness, and aggravated seizure activity. More severe adverse reactions are rare, but have been reported and include encephalopathy, hypotension, wide complex tachycardia, cardiac arrest, and death. Lamotrigine drug levels do not consistently correlate with either therapeutic effect or toxicity, though higher levels are thought to have a higher risk of toxicity. Also, the level is typically a send out test with a 1 to 3 …

Screening For And Diagnosing Malnutrition In Hospitalized Pediatric Patients, Samuel Thompson, Erin Lamers-Johnson, Kathryn Kelley, Lindsay Woodcock, Julie Long, Courtney Bliss, Jenica K. Abram, Alison Steiber, Elizabeth Yakes Jimenez

2020 Pediatric Research Forum Session

Background:

Malnutrition is often underdiagnosed, and consequently undertreated, in hospitalized patients. A nationwide study is being conducted to validate indicators (the Malnutrition Clinical Characteristics [MCC]) to diagnose malnutrition in hospitalized patients.

Methods:

For the full study, sixty pediatric hospitals will collect patient medical history, patient STRONGKids malnutrition screening score, and nutrition intervention data. Six hundred pediatric patients will be randomly selected from the cohort to be assessed for the MCC and the Nutrition Focused Physical Exam (NFPE). Medical outcomes will be collected for all patients for a three-month period thereafter. Baseline data from a subset of sites that have started …

What Procedural Skills Are Practiced By Pediatricians In New Mexico?, Christal P. Chow, Anne Greene, Grace Mccauley

2020 Pediatric Research Forum Session

Background:

By the end of residency, pediatric residents are expected to be competent in 13 clinical procedures (bag mask ventilation, neonatal endotracheal intubation, umbilical catheter placement, lumbar puncture, simple laceration repair, incision and drainage of abscess, reduction of simple dislocation, temporary splinting of fractures, giving immunizations, bladder catheterization, peripheral intravenous catheter placement, removal of foreign body, and venipuncture). These procedural skills were initially identified as essential for practice in the general pediatric setting. However, procedures performed vary based on location, patient population, practice type, tertiary care support, etc. There are few studies available that evaluate the procedural skills used in …

Healers Of Tomorrow Zia Youth Project, Eliana Garcia, Emelia Pino, Anthony Fleg, Daisy Belmares-Ortega, Kevin Dileanis, Talyia Torres

2020 Pediatric Research Forum Session

This youth advocacy effort follows the story of high school student Emelia Pino and Healers of Tomorrow leaders as they work to address health inequities in her home of Zia Pueblo, one of the communities hit hardest in New Mexico by the pandemic.

While taking part in The Healers of Tomorrow Program, a mentorship program for underrepresented high school students, Emelia conveyed the hardships her people were experiencing to program leaders. This kickstarted allied relief efforts in response to rising COVID-19 cases. Emilia and her mentors worked alongside several organizations, including NHI and Protect New Mexico, to gather PPE and …