Medical Specialties Commons^™

Opportunities To Address Obesity Disparities Among High-Risk Latino Children And Adolescents, Erica G Soltero, Teresia M O'Connor, Deborah Thompson, Gabriel Q Shaibi

Children’s Nutrition Research Center Staff Publications

Purpose of review: This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity.

Recent findings: Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact …

Theoretical Mediators Of Diabetes Risk And Quality Of Life Following A Diabetes Prevention Program For Latino Youth With Obesity, Erica G Soltero, Stephanie L Ayers, Marvyn A Avalos, Armando Peña, Allison N Williams, Micah L Olson, Yolanda P Konopken, Felipe G Castro, Kimberly J Arcoleo, Colleen S Keller, Donald L Patrick, Justin Jager, Gabriel Q Shaibi

Children’s Nutrition Research Center Staff Publications

Purpose: This study tested self-efficacy and social support for activity and dietary changes as mediators of changes in type 2 diabetes related outcomes following a lifestyle intervention among Latino youth.

Setting and intervention: Latino adolescents (14-16 years) with obesity (BMI% = 98.1 ± 1.4) were randomized to a 3-month intervention (n = 67) that fostered self-efficacy and social support through weekly, family-centered sessions or a comparison condition (n = 69).

Measures: Primary outcomes included insulin sensitivity and weight specific quality of life. Mediators included self-efficacy, friend, and family social support for health behaviors. Data was collected at baseline, 3-months, 6-months, …

Challenges In Feeding Children Posed By The Covid-19 Pandemic: A Systematic Review Of Changes In Dietary Intake Combined With A Dietitian's Perspective, Heather Campbell, Alexis C Wood

Children’s Nutrition Research Center Staff Publications

Purpose of review: To examine the evidence that the dietary quality of children changed between the period preceding the COVID-19 pandemic and the first year during the pandemic.

Recent findings: A systematic review of the evidence for dietary changes occurring as a result of the pandemic-related restrictions, in Part I of this article, yielded 38 original research articles. These articles had conflicting results, some describing improvements in overall quality and some describing deteriorations. As a whole the studies were characterized by a low study quality, and children were poorly represented. Taken together, these studies do not provide enough evidence to …

Tcf7l2 Genetic Variants Do Not Influence Insulin Sensitivity Or Secretion Indices In Autoantibody-Positive Individuals At Risk For Type 1 Diabetes, Maria J Redondo, Megan V Warnock, Ingrid M Libman, Laura E Bocchino, David Cuthbertson, Susan Geyer, Alberto Pugliese, Andrea K Steck, Carmella Evans-Molina, Dorothy Becker, Jay M Sosenko, Fida Bacha, Type 1 Diabetes Trialnet Study Group

Children’s Nutrition Research Center Staff Publications

Objective: We aimed to test whether type 2 diabetes (T2D)-associated TCF7L2 genetic variants affect insulin sensitivity or secretion in autoantibody-positive relatives at risk for type 1 diabetes (T1D).

Research design and methods: We studied autoantibody-positive TrialNet Pathway to Prevention study participants (N = 1,061) (mean age 16.3 years) with TCF7L2 single nucleotide polymorphism (SNP) information and baseline oral glucose tolerance test (OGTT) to calculate indices of insulin sensitivity and secretion. With Bonferroni correction for multiple comparisons, P values < 0.0086 were considered statistically significant.

Results: None, one, and two T2D-linked TCF7L2 alleles were present in 48.1%, 43.9%, and 8.0% of the participants, respectively. Insulin sensitivity …

Does Low Income Effects 5-Year Mortality Of Hepatocellular Carcinoma Patients?, Dong Jun Kim, Ji Won Yoo, Jong Wha Chang, Takashi Yamashita, Eun-Cheol Park, Kyu-Tae Han, Seung Ju Kim, Sun Jung Kim

School of Medicine Faculty Research

Background: In Korea, the universal health system offers coverage to all members of society. Despite this, it is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. We evaluated the impact of low income on HCC mortality. Methods: The Korean National Health Insurance sampling cohort was used to identify new HCC cases (n = 7325) diagnosed between 2004 and 2008, and the Korean Community Health Survey data were used to investigate community-level effects. The main outcome was 5-year all-cause mortality risk, and Cox proportional hazard models were applied to investigate the individual- and community-level factors associated …

Valproic Acid Autoinduction: A Case-Based Review, Sean Bennett, Mujeeb U. Shad

School of Medicine Faculty Research

Although valproic acid (VPA) induces the metabolism of multiple other drugs, the clinical reports of VPA autoinduction are rare. A comprehensive literature search yielded only one published case series, which provided the rationale to conduct a review of the published cases along with a new case of VPA autoinduction. Although there may be myriad of reasons for lack of published cases of VPA autoinduction, potential underreporting may be one of the core reasons. Lack of understanding into the highly complex metabolism of VPA may also make it difficult to recognize and report VPA autoinduction. However, it is important to mention …

Diabetes Detection And Prevention In Dermatology, Alexandra Ngo, Luise Froessl, John Wesley Mcwhorter, William Brett Perkison, Rajani Katta

Faculty, Staff and Student Publications

We are currently in the midst of an international epidemic of diabetes mellitus (DM) and prediabetes. The prevalence of DM in the United States is estimated at 9.4% of the population across all ages, while an estimated 1 in 3 Americans (33.9%) has prediabetes. According to the WHO, about 60 million people suffer from diabetes in the European Region. Dermatologists may play an important role in tackling this epidemic via efforts to improve early detection of both diabetes and prediabetes. Dermatologists often treat patients with, or at risk of, diabetes. This includes patients who present with cutaneous manifestations such as …

Exome Sequence Association Study Of Levels And Longitudinal Change Of Cardiovascular Risk Factor Phenotypes In European Americans And African Americans From The Atherosclerosis Risk In Communities Study, Elena V Feofanova, Elise Lim, Han Chen, Minjae Lee, Ching-Ti Liu, L Adrienne Cupples, Eric Boerwinkle

Faculty, Staff and Student Publications

Cardiovascular disease (CVD) is responsible for 31% of all deaths worldwide. Among CVD risk factors are age, race, increased systolic blood pressure (BP), and dyslipidemia. Both BP and blood lipids levels change with age, with a dose-dependent relationship between the cumulative exposure to hyperlipidemia and the risk of CVD. We performed an exome sequence association study using longitudinal data with up to 7805 European Americans (EAs) and 3171 African Americans (AAs) from the Atherosclerosis Risk in Communities (ARIC) study. We assessed associations of common (minor allele frequency > 5%) nonsynonymous and splice-site variants and gene-based sets of rare variants with levels …

Multicenter Outcomes After Hip Arthroscopy: Comparative Analysis Of Patients Undergoing Concomitant Labral Repair And Ligamentum Teres Debridement Versus Isolated Labral Repair, Blake Bodendorfer, Thomas Alter, Steven Defroda, Andrew Wolff, Dominic Carreira, John Cristoforetti, Dean Matsuda, John Salvo, Benjamin Kivlan, Shane Nho

Department of Orthopaedic Surgery Faculty Papers

Background: Increased attention has been directed toward the ligamentum teres (LT) and its association with acetabular coverage, labral pathology, and hip microinstability; however, few studies have evaluated whether LT pathology influences the rate of clinically significant outcome improvement after hip arthroscopy. Purpose: To determine if patients with femoroacetabular impingement syndrome (FAIS) undergoing labral repair and concomitant LT debridement achieve outcomes similar to patients without LT pathology undergoing labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of a prospectively maintained multicenter database for hip arthroscopy. Included were patients with FAIS who underwent primary …

Effectiveness And Safety Of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients With Active Cancer, Steve Deitelzweig, Allison V. Keshishian, Yan Zhang, Amiee Kang, Amol D. Dhamane, Xuemei Luo, Christian Klem, Mauricio Ferri, Jenny Jiang, Huseyin Yuce, Gregory Y.H. Lip

Publications and Research

BACKGROUND Patients with cancer are more likely to develop nonvalvular atrial fibrillation (NVAF). Currently there are no definitive clinical trials or treatment guidelines for NVAF patients with concurrent cancer.

OBJECTIVES This subgroup analysis of the ARISTOPHANES study compared the risk of stroke/systemic embolism (stroke/SE) and major bleeding (MB) among NVAF patients with active cancer who were prescribed non–vitamin K antagonist oral anticoagulants (NOACs) or warfarin.

METHODS A retrospective observational study was conducted in NVAF patients with active cancer who newly initiated apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, through September 30, 2015, with the use of Medicare and …

Predicting Long-Term Hepatocellular Carcinoma Response To Transarterial Radioembolization Using Contrast-Enhanced Ultrasound: Initial Experiences., Lauren J. Delaney, M. Tantawi, Corinne Wessner, Priscilla Machado, Flemming Forsberg, Andrej Lyshchik, Patrick O'Kane, Ji-Bin Liu, Jesse M. Civan, Alison Tan, Kevin Anton, Colette Shaw, John R. Eisenbrey

Department of Radiology Faculty Papers

Conventional cross-sectional imaging done shortly after radioembolization of hepatocellular carcinoma (HCC) does not reliably predict long-term response to treatment. This study evaluated whether quantitative contrast-enhanced ultrasound (CEUS) can predict the long-term response of HCC to yttrium-90 (Y-90) treatment. Fifteen patients underwent CEUS at three time points: immediately following treatment and 1 and 2 wk post-treatment. Response 3-6 mo after treatment was categorized on contrast-enhanced magnetic resonance imaging by two experienced radiologists using the Modified Response Evaluation Criteria in Solid Tumors. CEUS data were analyzed by quantifying tumor perfusion and residual fractional vascularity using time-intensity curves. Patients with stable disease on …

Causes And Circumstances Of Maternal Death: A Secondary Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials Cohort, Annet M. Aukes, Kristina Arion, Jeffrey N. Bone, Jing Li, Marianne Vidler, Mrutyunjaya B. Bellad, Zahra Hoodbhoy, Rahat Qureshi, Sana Sheikh, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Incomplete vital registration systems mean that causes of death during pregnancy and childbirth are poorly understood in low-income and middle-income countries. To inform global efforts to reduce maternal mortality, we compared physician review and computerised analysis of verbal autopsies (interpreting verbal autopsies [InterVA] software), to understand their agreement on maternal cause of death and circumstances of mortality categories (COMCATs) in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials.
Methods: The CLIP trials took place in India, Pakistan, and Mozambique, enrolling pregnant women aged 12-49 years between Nov 1, 2014, and Feb 28, 2017. 69 330 pregnant women were …

Circulating Fatty Acids Associated With Advanced Liver Fibrosis And Hepatocellular Carcinoma In South Texas Hispanics, Jingjing Jiao, Suet-Ying Kwan, Caroline M. Sabotta, Honami Tanaka, Lucas Veillon, Marc O. Warmoes, Philip L. Lorenzi, Ying Wang, Peng Wei, Jose Luis Almeda, Joseph B. Mccormick, Susan P. Fisher-Hoch

School of Medicine Publications

Background: Hispanics in South Texas have high rates of hepatocellular carcinoma (HCC) and nonalcoholic fatty liver disease (NAFLD). Liver fibrosis severity is the strongest predictive factor of NAFLD progression to HCC. We examined the association between free fatty acids (FA) and advanced liver fibrosis or HCC in this population.

Methods: We quantified 45 FAs in plasma of 116 subjects of the Cameron County Hispanic Cohort, 15 Hispanics with HCC, and 56 first/second-degree relatives of Hispanics with HCC. Liver fibrosis was assessed by FibroScan.

Results: Advanced liver fibrosis was significantly associated with low expression of very long chain (VLC) saturated FAs …

Medical And Device Therapy For Stroke Prevention In Patients With Atrial Fibrillation, Sophia Huang, Payam Safavi-Naeini, Abdi Rasekh

The Texas Heart Institute Journal

No abstract provided.

Endoleaks: Current Concepts And Treatments - A Narrative Review, Zia Ur Rehman

Department of Surgery Docs

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks (type I and III) have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction. Indirect endoleaks ( type II, IV and V) have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. …

Mortality In Children Treated With Maintenance Peritoneal Dialysis: Findings From The International Pediatric Peritoneal Dialysis Network Registry., Sophie Ploos Van Amstel, Marlies Noordzij, Dagmara Borzych-Duzalka, Nicholas C. Chesnaye, Hong Xu, Lesley Rees, Il-Soo Ha, Zenaida L. Antonio, Nakysa Hooman, William Wong, Karel Vondrak, Yok Chin Yap, Hiren Patel, Maria Szczepanska, Sara Testa, Monica Galanti, Jameela A. Kari, Charlotte Samaille, Sevcan A. Bakkaloglu, Wai-Ming Lai, Luisa Fernanda Rojas, Mabel Sandoval Diaz, Biswanath Basu, Alicia Neu, Bradley A. Warady, Kitty J. Jager, Franz Schaefer

Manuscripts, Articles, Book Chapters and Other Papers

RATIONALE & OBJECTIVE: Research on pediatric kidney replacement therapy (KRT) has primarily focused on Europe and North America. In this study, we describe the mortality risk of children treated with maintenance peritoneal dialysis (MPD) in different parts of the world and characterize the associated demographic and macroeconomic factors.

STUDY DESIGN: Prospective cohort study.

SETTING & PARTICIPANTS: Patients younger than 19 years at inclusion into the International Pediatric Peritoneal Dialysis Network registry, who initiated MPD between 1996 and 2017.

EXPOSURE: Region as primary exposure (Asia, Western Europe, Eastern Europe, Latin America, North America, and Oceania). Other demographic, clinical, and macroeconomic (4 …

Whole-Genome Sequence-Informed Maldi-Tof Ms Diagnostics Reveal Importance Of Klebsiella Oxytoca Group In Invasive Infections: A Retrospective Clinical Study, Aline Cuénod, Daniel Wüthrich, Helena M. B. Seth-Smith, Chantal Ott, Christian Gehringer, Frédéric Foucault, Roxanne Mouchet, Ali Kassim, Gunturu Revathi, Deborah R. Vogt

Pathology, East Africa

Background: Klebsiella spp. are opportunistic pathogens which can cause severe infections, are often multi-drug resistant and are a common cause of hospital-acquired infections. Multiple new Klebsiella species have recently been described, yet their clinical impact and antibiotic resistance profiles are largely unknown. We aimed to explore Klebsiella group- and species-specific clinical impact, antimicrobial resistance (AMR) and virulence.

Methods: We analysed whole-genome sequence data of a diverse selection of Klebsiella spp. isolates and identified resistance and virulence factors. Using the genomes of 3594 Klebsiella isolates, we predicted the masses of 56 ribosomal subunit proteins and identified species-specific marker masses. …

Management And Outcomes For Long-Segment Hirschsprung Disease: A Systematic Review From The Apsa Outcomes And Evidence Based Practice Committee, Akemi L Kawaguchi, Yigit S Guner, Stig Sømme, Alexandria C Quesenberry, L Grier Arthur, Juan E Sola, Cynthia D Downard, Rebecca M Rentea, Patricia A Valusek, Caitlin A Smith, Mark B Slidell, Robert L Ricca, Roshni Dasgupta, Elizabeth Renaud, Doug Miniati, Jarod Mcateer, Alana L Beres, Julia Grabowski, Shawn D St Peter, Ankush Gosain, American Pediatric Surgical Association Outcomes And Evidence-Based Practice (Oebp) Committee

Faculty, Staff and Student Publications

OBJECTIVE: Long-Segment Hirschsprung Disease (LSHD) differs clinically from short-segment disease. This review article critically appraises current literature on the definition, management, outcomes, and novel therapies for patients with LSHD.

METHODS: Four questions regarding the definition, management, and outcomes of patients with LSHD were generated. English-language articles published between 1990 and 2018 were compiled by searching PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar. A qualitative synthesis was performed.

RESULTS: 66 manuscripts were included in this systematic review. Standardized nomenclature and preoperative evaluation for LSHD are recommended. Insufficient evidence exists to recommend a single method …

Use Of Human Tissue Stem Cell-Derived Organoid Cultures To Model Enterohepatic Circulation, Sarah E Blutt, Sue E Crawford, Carolyn Bomidi, Xi-Lei Zeng, James R Broughman, Matthew Robertson, Cristian Coarfa, Mary Elizabeth M Tessier, Tor Savidge, F Blaine Hollinger, Steven A Curley, Mark Donowitz, Mary K Estes

Faculty, Staff and Students Publications

The use of human tissue stem cell-derived organoids has advanced our knowledge of human physiological and pathophysiological processes that are unable to be studied using other model systems. Increased understanding of human epithelial tissues including intestine, stomach, liver, pancreas, lung, and brain have been achieved using organoids. However, it is not yet clear whether these cultures recapitulate in vivo organ-to-organ signaling or communication. In this work, we demonstrate that mature stem cell-derived intestinal and liver organoid cultures each express functional molecules that modulate bile acid uptake and recycling. These organoid cultures can be physically coupled in a Transwell system and …

Hemodynamic Outcomes After Valve-In-Valve Transcatheter Aortic Valve Replacement: A Single-Center Experience, R Yazan Kherallah, Srikanth Koneru, Zvonimir Krajcer, Ourania Preventza, Kathryn G Dougherty, Melissa L Mccormack, Briana T Costello, Stephanie Coulter, Neil E Strickman, Juan Carlos Plana Gomez, Ali Mortazavi, Jose G Díez, James J Livesay, Joseph S Coselli, Guilherme V Silva

Faculty, Staff and Students Publications

BACKGROUND: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis.

METHODS: We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and …

Extracorporeal Membrane Oxygenation Rescue For Severe Aspiration Pneumonitis In Two Patients After Roux-En-Y Gastric Bypass Procedure, Melissa M Felinski, Daniyal Abbas, Peter A Walker, John A Primomo, Tanyaradzwa M Kajese, Biswajit Kar, Igor D Gregoric, Igor Banjac, Lisa Janowiak, Sriram Nathan, Rahat Hussain, Sheilendra S Mehta, Kulvinder S Bajwa, Shinil K Shah, Bindu Akkanti

Faculty, Staff and Student Publications

Roux-en-y gastric bypass (RYGB) is one of the most common weight loss surgical procedures performed in the United States. Early post-operative small bowel obstruction is a rare but potentially morbid, complication of RYGB. We report two patients who underwent RYGB and required subsequent treatment for a post-operative small bowel obstruction. Their post-operative course was complicated by severe aspiration pneumonitis leading to hypoxemic respiratory failure requiring rescue with femoral veno-venous extracorporeal membrane oxygenation (V-V ECMO). Both patients were successfully extubated, weaned off V-V ECMO support, and discharged to home. These cases highlight the potential role of V-V ECMO for patients who …

First-In-Human Segmental Esophageal Reconstruction Using A Bioengineered Mesenchymal Stromal Cell-Seeded Implant, Johnathon M Aho, Saverio La Francesca, Scott D Olson, Fabio Triolo, Jeff Bouchard, Laura Mondano, Sumati Sundaram, Christina Roffidal, Charles S Cox, Louis M Wong Kee Song, Sameh M Said, William Fodor, Dennis A Wigle

Faculty, Staff and Student Publications

INTRODUCTION: Resection and reconstruction of the esophagus remains fraught with morbidity and mortality. Recently, data from a porcine reconstruction model revealed that segmental esophageal reconstruction using an autologous mesenchymal stromal cell-seeded polyurethane graft (Cellspan esophageal implant [CEI]) can facilitate esophageal regrowth and regeneration. To this end, a patient requiring a full circumferential esophageal segmental reconstruction after a complex multiorgan tumor resection was approved for an investigational treatment under the Food and Drug Administration Expanded Access Use (Investigational New Drug 17402).

METHODS: Autologous adipose-derived mesenchymal stromal cells (Ad-MSCs) were isolated from the Emergency Investigational New Drug patient approximately 4 weeks before …

Primary Ciliary Dyskinesia: Ancestral Haplotypes Analysis Of The Rsph4a Founder Mutation In Puerto Rico, Wilfredo De Jesús-Rojas, Dalilah Reyes De Jesús, Angélica M Nieves, Ricardo A Mosquera, Juan C Martinez-Cruzado

Faculty, Staff and Student Publications

Genetic mutations in >50 genes, including RSPH4A, can lead to primary ciliary dyskinesia (PCD). RSPH4A mutations affect radial spokes, which alter the configuration of the ciliary ultrastructure and lead to chronic oto-sinopulmonary disease. The RSPH4A [c.921+3_6delAAGT] founder mutation was described as one cause of PCD without laterality defects in Puerto Rico. The average Puerto Rican genetic composition includes 64% European, 21% African ancestral, and 15% Native-American or Taino, a native tribe in the Caribbean at the start of the European colonization, genes. Due to the relatively elevated Taino ancestry on the island, it might have contributed to the endemicity of …

Primary Osteoarthritis Early Joint Degeneration Induced By Endoplasmic Reticulum Stress Is Mitigated By Resveratrol, Jacqueline T Hecht, Alka C Veerisetty, Juliana Wu, Francoise Coustry, Mohammad G Hossain, Frankie Chiu, Francis H Gannon, Karen L Posey

Faculty, Staff and Student Publications

Increasing numbers of people are living with osteoarthritis (OA) due to aging and obesity, creating an urgent need for effective treatment and preventions. Two top risk factors for OA, age and obesity, are associated with endoplasmic reticulum (ER) stress. The I-ERS mouse, an ER stress-driven model of primary OA, was developed to study the role of ER stress in primary OA susceptibility. The I-ERS mouse has the unique ability to induce ER stress in healthy adult articular chondrocytes and cartilage, driving joint degeneration that mimics early primary OA. In this study, ER stress-induced damage occurred gradually and stimulated joint degeneration …

Are Body Surface Area Based Estimates Of Liver Volume Applicable To Children With Overweight Or Obesity? An In Vivo Validation Study., Chelsea Hosey-Cojocari, Sherwin S. Chan, Chance S. Friesen, Amie L. Robinson, Veronica Williams, Erica Swanson, Daniel O'Toole, Jansynn Radford, Neil J. Mardis, Trevor N. Johnson, J Steven Leeder, Valentina Shakhnovich

Manuscripts, Articles, Book Chapters and Other Papers

The liver is the primary organ responsible for clearing most drugs from the body and thus determines systemic drug concentrations over time. Drug clearance by the liver appears to be directly related to organ size. In children, organ size changes as children age and grow. Liver volume has been correlated with body surface area (BSA) in healthy children and adults and has been estimated by functions of BSA. However, these relationships were derived from "typical" populations and it is unknown whether they extend to estimations of liver volumes for population "outliers," such as children with overweight or obesity, who today …

Secondary Bacterial Pneumonias And Bloodstream Infections In Patients Hospitalized With Covid-19, Max W Adelman, Divya R Bhamidipati, Alfonso C Hernandez-Romieu, Ahmed Babiker, Michael H Woodworth, Chad Robichaux, David J Murphy, Sara C Auld, Colleen S Kraft, Jesse T Jacob

Faculty, Staff and Student Publications

No abstract provided.

Delirium In Frail Older Adults, Min Ji Kwak

Faculty, Staff and Student Publications

Delirium and frailty are prevalent geriatric syndromes and important public health issues among older adults. The prevalence of delirium among hospitalized older adults ranges from 15% to 75%, while that of frailty ranges from 12% to 24%. The exact pathophysiology of these two conditions has not been clearly identified, although several hypotheses have been proposed. However, these conditions are considered to be multifactorial in etiology and are associated with inflammation related to aging, alterations in vascular systems, genetics, and nutritional deficiency. Furthermore, clinically, they are significantly associated with frailty, which increases the risk of delirium by almost two- to three-fold …

Diagnosis And Management Of Diffuse Large B-Cell Lymphoma: Society Of Medical Oncology, Pakistan Society Of Hematology, And Pakistan Society Of Clinical Oncology Joint Clinical Practice Guideline, Raheel Iftikhar, Muhammad Ayaz Mir, Munira Moosajee, Kamran Rashid, Syed Waqas Bokhari, Ahmed Nadeem Abbasi, Tahir Sultan Shamsi, Mohammad Usman Shaikh, Natasha Bahadur Ali, Salman Adil

Section of Haematology/Oncology

Diffuse large B-cell lymphoma (DLBCL) is the commonest non-Hodgkin lymphoma encountered by hematopathologists and oncologists. Management guidelines for DLBCL are developed and published by countries with high income and do not cater for practical challenges faced in resource-constrained settings. This report by a multidisciplinary panel of experts from Pakistan is on behalf of three major national cancer societies: Society of Medical Oncology Pakistan, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology. The aim is to develop a practical and standardized guideline for managing DLBCL in Pakistan, keeping in view local challenges, which are similar across most of the …

Aortic Fistulas: Pathophysiologic Features, Imaging Findings, And Diagnostic Pitfalls, Aishwarya Gulati, Md, Harit Kapoor, Md, Achala Donuru, Mbbs, Frcr, Kunal Gala, Mbbs, Dnb, Maansi Parekh, Mbbs, Dnb

Department of Radiology Faculty Papers

Fistulas between the aorta and surrounding organs are extremely rare but can be fatal if they are not identified and treated promptly. Most of these fistulas are associated with a history of trauma or vascular intervention. However, spontaneous aortic fistulas (AoFs) can develop in patients with weakened vasculature, which can be due to advanced atherosclerotic disease, collagen-vascular disease, vasculitides, and/or hematogenous infections. The clinical features of AoFs are often nonspecific, with patients presenting with bleeding manifestations, back or abdominal pain, fever, and shock. Confirmation with invasive endoscopy is often impractical in the acute setting. Imaging plays an important role in …

Expandable Intravertebral Implants: A Narrative Review On The Concept, Biomechanics, And Outcomes In Traumatology., Diogo L Moura, Josue P Gabriel

Surgery Articles

Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed …