Medical Specialties Commons^™

Continued Aspirin Use And Bleeding Risk After Endoscopic Submucosal Dissection Of Gastric Neoplasms: A Meta-Analysis, Hermant Goyal Md, Sonali Sachdeva Mbbs, Abhilash Perisetti Md, Mark M. Aloysius Md, Saurabh Chandan Md, Benjamin Tharian Md, Nirav Thosani Md

Other Specialties

Introduction:

With the development of endoscopic technologies, the detection rate of early gastric cancer (EGC) and precancerous lesions is gradually increasing. As an effective minimally invasive therapy, endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for EGC and dysplasia. However, postprocedural bleeding is one of the most common complications of ESD, with a reported incidence of 5.1%. Moreover, the effect of continued low-dose aspirin (LDA) on bleeding during the peri-ESD period is not clear.

Methods:

We searched the OVID/Medline and Google Scholar databases through June 2021 to find studies relating to continued LDA use in patients undergoing …

Working With Fellows Improves Adenoma Detection Rate During Screening Colonoscopies., Mark M Aloysius, Hemant Goyal, Niraj James Shah, Abhilash Perisetti Md, Benjamin Tharian

Other Specialties

No abstract provided.

The Many Faces Of Covid19 Infection: A Case Of Multisystem Inflammatory Syndrome In Adults (Mis-A), Amy Lam Do, Kaitlyn Musco Md, Nicholas Hinds Md

Posters

No abstract provided.

Association Between Pitch Break On The 4-Seam Fastball And Slider And Shoulder Injury In Major League Baseball Pitchers: A Case-Control Study, Brooks N. Platt, Anthony J. Zacharias, Caitlin Conley, Lindsay Hockensmith, Nicholas Stockwell, Aaron Sciascia, Austin V. Stone

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Few specific risk factors are known for shoulder injury in professional pitchers. New pitch-tracking data allow for risk stratification based on advanced metrics.

Purpose/Hypothesis: The purpose of this study was to determine the association between shoulder injury, pitch frequency, and pitch metrics (velocity, total break, break angle, and spin rate) for the 4-seam fastball, curveball, and slider. We hypothesized that more frequent use of the 4-seam fastball would be associated with shoulder injury.

Study Design: Case-control study; Level of evidence, 3.

Methods: The Major League Baseball (MLB) database was queried for pitchers who had been placed on the injury …

Gastric Sleeve Eras - Use Of Transverse Abdominal Plane (Tap) Blocks And Reduction Of Pain In Laparoscopic Gastric Bypass Patient, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Safety Of Glucagon Use During Endoscopic Retrograde Cholangiopancreatography: A Retrospective Multicentric Study, Abhilash Perisetti Md, Hermant Goyal Md, Syed Mahanazuddin Phd, Rupinder Mann Md, Saurabh Chandan Md, Benjamin Tharian Md, Neil Sharma Md

Other Specialties

Introduction- Injectable glucagon inhibits gastrointestinal (GI) and duodenal motility by relaxing smooth muscles, decreasing the frequency and amplitude of phasic activity of the sphincter of Oddi. This enables endoscopists to enhance biliary cannulation and extract small bile duct stone. Additionally, glucagon can potentially worsen underlying hyperglycemia and hyperkalemia especially in patients with diabetes. It is unclear if glucagon impacts the adverse events of Endoscopic Retrograde Cholangiopancreatography (ERCP) such as rates of GI bleeding, GI perforation, post-ERCP pancreatitis (PEP) and in patient hospitalizations.

Methods We used TriNetX, a federated cloud-based network comprising of 92 healthcare organizations (HCOs) across the US. All …

Impact Of Pandemic On Epidemiology And Management Of Acute Colonic Pseudo Obstruction: Nationwide Clinical Data Research Network, Abhilash Perisetti Md, Hermant Goyal Md, Syed Mahanazuddin Phd, Mariajose Rojas Md, Mahesh Gajendran Md, Syed Ali Amir Sherazi Md, Shweta Gupta Md, Mbs, Ragesh Thandassery Md, Benjamin Tharian Md, Mrcp, Fracp, Neil Sharma Md

Other Specialties

Introduction Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is characterized by massive acute dilatation of the large intestine without a mechanical cause. Early recognition to identify serious adverse events such as ischemia/ perforation is critical to reducing mortality rates. COVID-19 pandemic led to a significant shift of resources for the treatment of patients with reduced utilization of endoscopy and imaging, which could have impacted outcomes in patients with ACPO. In this study, we aim to identify the change in the clinical outcomes in ACPO patients in 2020.

Methods All adult patients with a new diagnosis of intestinal obstruction …

National Trends In The Incidence Of Sporadic Malignant Colorectal Polyps In Young Patients (20-49 Years): An 18-Year Seer Database Analysis, Mark M. Aloysius Md, Hermant Goyal Md, Aman Ali Md, Niraj Shah Nd, Mahesh Gajendran Md, Abhilash Perisetti Md, Patrick Basu Md, Rajiv Chhabra Md, Benjamin Tharian Md

Other Specialties

Introduction:

Recent changes in the USPSTF guidelines recommend that CRC (Colorectal Cancer) screening in average-risk patients should commence at 45 years with the intent of finding sporadic premalignant or malignant polyps, allowing early endoscopic interventions to improve clinical outcomes. This study aims to find the incidence of sporadic malignant polyps in adult patients < 50 years of age) from the National Cancer Institute's SEER (Surveillance Epidemiology and End Results) database over a period of 18 years.

Methods:

We interrogated the SEER database (2000-2017) on patients aged 20-49 years diagnosed with at least a single malignant sporadic colorectal polyp. Data extraction was performed through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with …

Skin Soft Tissue Infection: Antibiotics For Abscesses, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Severe Hypertriglyceridemia: Care For The Non-Diabetic Patient, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

The Mental Well-Being And Coping Strategies Of Canadian Adolescents During The Covid-19 Pandemic: A Qualitative, Cross-Sectional Study, Kendra Nelson Ferguson, Stephanie E. Coen, Danielle Tobin, Gina Martin, Jamie A. Seabrook, Jason A. Gilliland

Paediatrics Publications

BACKGROUND: Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions. METHODS: Participants living in Canada aged 13-19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: "What feelings and emotions have you experienced around the pandemic?" and "What coping strategies have you used during the …

Spiritual Care Competency Of Critical Care Nurses: A Literature Review, Julia O. Rohm

Bachelors of Science in Nursing

While caring for their patients, nurses often encounter spiritual needs. In a study with 241 hospice, palliative care, and holistic nurses, “all respondents (100%) indicated they had encountered a patient with spiritual needs throughout their nursing clinical practice” (Lukovsky et al., 2021, p. 32). Despite the prevalence of spiritual needs, many nurses feel unable to confront spiritual issues among their patients. According to a survey conducted among 4054 nurses from the UK, “almost 93% of the nurses surveyed believed spiritual care should be addressed, yet only 5.3% felt always able to meet the spiritual need of patients on a regular …

A Curriculum Model For Multidisciplinary Training Of Midwife Sonographers In A Low Resource Setting, Sudhir Vinayak, Marleen Temmerman, Geert Villeirs, Sharon M. Brownie

Imaging & Diagnostic Radiology, East Africa

In many low-resource settings, less than 5% of pregnant women can access ultrasound during pregnancy. Thus, gestational age is often difficult to determine, multiple pregnancies are diagnosed late and foetal and pregnancy-related anomalies can go undetected. A pilot solution was designed beyond the traditional approach of increasing numbers of qualified radiologists, gynaecologists and sonographers. An innovative Human Resource for Health (HRH) task sharing, and maternal child health (MCH) workforce training and capacity building initiative was designed, involving development and testing of a curriculum to train midwife sonographers via a teleradiology innovation platform and a partnership between specialist radiologists, sonographers and …

Mindfulness In The Emergency Department (Med): An Asynchronous Learning Course To Practise Mindfulness And Resilience In The Emergency Room Of Low Resource Setting, Syed Maaz Salahuddin, Shahan Waheed

Department of Emergency Medicine

Owing to the fast-paced, stressful, and frequent crucial rapid decisions that trigger cognitive exhaustion, emergency physicians are especially vulnerable to burnout. Mindfulness practices have been defined in the literature and it focuses on the well-being and resilience. Mindfulness is characterised as the ability to use tools and expertise to mentally respond to environmental problems to fulfil psychological needs. To overcome burnout, a self-directed learning course was developed for emergency physicians that will include learning goals on mindfulness, peer group discussions and tasks, role playing and practising meditation exercises. It would concentrate on the foundations of mindfulness and resilience, learning and …

Racial Disparities In Testicular Torsion, Kayla B. Briggs, Obiyo O. Osuchukwu, Chris E. Roberts, James Fraser, Wendy Jo Svetanoff, Tolulope A. Oyetunji, Hanna Alemayehu

Posters

Racial Disparities in Testicular Torsion Introduction: Testicular torsion (TT) is a surgical emergency requiring prompt intervention to preserve testicular function. Race and insurance status are thought to be associated with higher rates of gonadal loss; however, reports in the literature are conflicting. We sought to determine the effect of race on the treatment and outcomes of testicular torsion. Methods: Following IRB approval, a retrospective review was conducted of patients <18 years of age who presented to 2 institutions (hereby referred to as H1 and H2) with acute scrotal pain between December 2017 and September 2019. Demographic data, clinical history, imaging results, diagnosis, and surgical outcomes were recorded. Social vulnerability index (SVI), as determined by zip code, was obtained from the Centers for Disease Control and dichotomized using the 75th percentile. Higher SVI denotes increased social vulnerability. Primary outcome was diagnosis of TT. Secondary outcomes included orchiectomy rates. A p-value <0.05 was considered significant. Results: A total of 515 patients (H1 85%, H2 15%) were included in the final analysis. There were no difference in median age, BMI, TT diagnosis and orchiectomy rate between the two institutions. H2 treated more black patients (43% vs. 14%, p=<0.01) and patients with public insurance (57% vs. 41%, p=0.03) compared to H1. In multivariate analysis, older age was associated with TT (median age TT 14.12 years [12.13,15.69]) vs. no TT 9.86 years [5,13.05], OR 1.35, 95% CI 1.18-1.55, p=<0.01). Black patients were ~4 times more likely (OR 4.05, 95% CI 2.13-7.69, p=<0.01) than white patients to be diagnosed with TT when controlled for dichotomized SVI, insurance, and age. In the same model, Hispanic patients were ~2 times more likely (OR 2.20, 95% CI 1.10-4.40, p=0.03) to be diagnosed with TT when compared to white patients. Despite more black and Hispanic patients having dichotomized SVI >75th percentile than white patients (70% and 82%, respectively vs. 16%, p=<0.01), dichotomized SVI was not found to be associated with higher rates of TT or orchiectomy, respectively. Conclusion: At the two centers, more black and Hispanic children had SVI >75th percentile, however, when controlling for this in multivariate analysis, they were significant more likely to be diagnosed with …

Short And Long Term Outcomes Of Using Cryoablation For Post-Operative Pain Control In Patients After Pectus Excavatum Repair, James Fraser, Kayla B. Briggs, Wendy Jo Svetanoff, David Juang, Pablo Aguayo, Jason D. Fraser, Charles L. Snyder, Tolulope A. Oyetunji, Shawn D. St. Peter Md

Posters

Background: Previous prospective trials have demonstrated that intercostal cryoablation reduces length of stay and postoperative opioid consumption compared with thoracic epidural and patient controlled analgesia (PCA) modalities. We report the findings of a 3-year prospective, observational study to elucidate long-term pain control, symptoms, and complications with attention to postoperative short and long-term pain control associated with the cryoablation technique.

Methods: Following IRB approval, we prospectively collected data on patients who underwent bar placement for pectus excavatum with thoracoscopic intercostal cryoablation by six surgeons at our institution from 2017 to 2021. Patients and their parents completed surveys regarding pain scores, narcotic …

Local Renin-Angiotensin System Activation And Myofibroblast Formation In Graft Versus Host Disease–Associated Conjunctival Fibrosis, Kiumars Shamloo, Judy Weng, Christopher Ross, Jenni Lee, Saleh Alfuraih, Jennifer Totonchy, Ajay Sharma

Pharmacy Faculty Articles and Research

Purpose: The present study was designed to investigate the role of myofibroblast transdifferentiation and the conjunctival renin–angiotensin system (RAS) in the pathogenesis of graft-versus-host disease (GVHD)–associated conjunctival fibrosis.

Methods: A mouse model of major histocompatibility-matched allogeneic transplantation was used to induce GVHD, with male B10.D2 mice as donors and female BALB/c mice as recipients. Male BALB/c to female BALB/c syngeneic transplantation was used as control. Y chromosome staining in the spleen cells obtained from female recipient mice was used to confirm engraftment. The phenol red thread test and fluorescein staining were used to quantify tears and corneal keratopathy. …

Helmintos Transmitidos Por El Suelo En Ecuador; La Respuesta Comunitaria Y Las Percepciones A Ellos En Baños Y Puyo, Audrey Chesney

Independent Study Project (ISP) Collection

This investigation was a qualitative study focused on soil-transmitted helminths (STHs) in Baños and Puyo, Ecuador. The perceptions of the communities regarding STHs and the community response to STH and STH infections was studied. The objectives of this study aimed to discover and learn about the perceptions of STHs from the affected communities, to comprehend the barriers that are present against better treatment for STH infections, and to learn about the community action taking place to improve the situation of soil-transmitted helminths (STHs) in the community. Soil transmitted helminths are intestinal worms that are transmitted through the contamination of the …

Draagmoederschap: Surrogacy In The Netherlands, Olivia Murray

Independent Study Project (ISP) Collection

In this paper, I investigated surrogacy in the Netherlands by interviewing four surrogates and one intended parent about their experiences. I found that the participants shared several common experiences and opinions, especially related to why they chose to be surrogates, how surrogates and intended parents negotiate their relationship during and after pregnancy, the tensions of passing on parenthood and merging families, the (non-binding) contracts that surrogates and parents create, Dutch law, and commercial surrogacy. I argue that much of the discourse around surrogacy relitigates many of the arguments made in favor and against sex work, in that it sets surrogacy …

Severe Diastolic Dysfunction Following Prolonged Extracorporeal Membrane Oxygenation In A Pediatric Burn Patient., Cara Holton, Johanna I. Orrick, Igor Areinamo, Jenna Miller

Posters

A previously healthy 3-year-old female was admitted following a 22% TBSA scald burn. She was initially hemodynamically stable on room air. However, one week into hospitalization she developed ARDS with catecholamine-refractory shock requiring VA-ECMO. She was enterovirus positive, grew MRSA in respiratory cultures and was treated with prolonged antibiotics. The patient spent 26 days on VA-ECMO followed by 61 days on VV- ECMO after failing decannulation due to refractory hypoxia. She developed anuric renal failure requiring CRRT during her second ECMO course. Following VV-ECMO decannulation, she required mechanical ventilation with high settings and had severe recurrent pulmonary hemorrhage requiring FFP, …

Perioperative Antibiotic Use In Neonatal General Surgery: A Survey Of Apsa Membership, Ashley Williams, Samuel K. Osei, Pavan Brahmamdam, Begum Akay, Diane Studzinski

Conference Presentation Abstracts

Background: Surgical site infections (SSIs) are a significant source of perioperative morbidity. There is limited data regarding antibiotic prophylaxis in pediatrics, and there are no standardized guidelines in neonates. Thus, peri-operative antibiotic use is based on surgeon experience and preference. To explore this knowledge gap, we sought to describe the practice patterns of pediatric surgeons with regard to antibiotic prophylaxis for SSIs in neonatal surgery

Methods: A survey was distributed to the American Pediatric Surgical Association (APSA). Members were asked to respond to 6 hypothetical case scenarios: Tracheoesophageal fistula/Esophageal atresia, Hirschsprung’s disease, Gastroschisis, Congenital diaphragmatic hernia repair, Neonatal intestinal obstruction …

Obesity Modulates The Gut Microbiome In Triple-Negative Breast Cancer, Fokhrul Hossain, Samarpan Majumder, Justin David, Bruce A. Bunnell, Lucio Miele

School of Medicine Faculty Publications

Triple-negative breast cancer (TNBC) is an aggressive, molecularly heterogeneous sub-type of breast cancer. Obesity is associated with increased incidence and worse prognosis in TNBC through various potential mechanisms. Recent evidence suggests that the gut microbiome plays a central role in the progression of cancer, and that imbalances or dysbiosis in the population of commensal microbiota can lead to inflammation and contribute to tumor progression. Obesity is characterized by low-grade inflammation, and gut dysbiosis is associated with obesity, chronic inflam-mation, and failure of cancer immunotherapy. However, the debate on what constitutes a “healthy” gut microbiome is ongoing, and the connection among …

How I Treat Neuroendocrine Tumors, Aasems Jacob, Gaby Gabriel, Robert A. Ramirez, Yi Zarn Wang, Lowell Anthony, Aman Chauhan

School of Medicine Faculty Publications

No abstract provided.

Patient Reported Outcomes Of Urinary Incontinence Rates Using Viable Cryopreserved Umbilical Tissue Over Neurovascular Bundles During Robotic Assisted Radical Prostatectomy, Samantha Kraemer, Mit Shah, Chirag Dave, Ji Qi, Fionna Sun, Sugandh Shetty, Brian Seifman, Jason Hafron

Conference Presentation Abstracts

Introduction: Incontinence remains a side effect from robotic assisted radical prostatectomy (RAP) for prostate cancer despite nerve sparing (NS) techniques. Use of growth factors and anti-inflammatory substances over neurovascular bundles is an emerging technique to enhance recovery of continence and potency. Viable cryopreserved umbilical tissue (vCUT) is FDA approved for homologous use in surgery. The objective is to determine if vCUT use in NS-RAP accelerates return to continence. Methods: Retrospective review of 176 patients who underwent NS-RAPs from October 2015 through July 2020 were identified through the Michigan Urological Surgery Improvement Collaborative (MUSIC). Return to social urinary continence (0-1 pads …

Fractional Carbon Dioxide Vaginal Laser For The Treatment Of Urinary Symptoms: Preliminary Short-Term Results, Annah Vollstedt, Lauren Tennyson, Michael Rezaee, Ly Hoang Roberts, Larry Sirls, Priya Padmanabhan, Kenneth M. Peters

Conference Presentation Abstracts

Introduction: It has been proposed that fractional carbon dioxide (fCO2) vaginal laser can also treat stress urinary incontinence (SUI) by increasing collagen production. The aim of our study was to evaluate the effect of vaginal fCO2 laser therapy in patients complaining of SUI. Methods: This is a prospective, open-label study of women over 18 years old with complaints of urogenital symptoms. Women with a history of vaginal estrogen use within the last 3 months were excluded. Participants received 3 laser treatments 6 weeks apart. Cough stress test (CST) was performed at each visit. Incontinence-Quality of Life (I-QOL), Questionnaire for Urinary …

The Altis Mid-Urethral Sling: One Surgeon's Experience With Immediate Post-Operative Adjustment, Jennifer Nguyen, Brett Friedman, Annah Vollstedt, Mireya Diaz, Ly Hoang Roberts, Larry Sirls

Conference Presentation Abstracts

Introduction: The Altis® transobturator sling uses a dynamic anchor on a pulley suture for intraoperative tension adjustment. Given the potential for over-tensioning seen with any sling, we have adopted a technique using the pulley suture that allows for sling tightening should stress urinary incontinence (SUI) persist in the immediate post-operative period or sling loosening if there is bladder outlet obstruction. Our objective is to describe our technique and rate of post-operative adjustment. Methods: In this single-surgeon experience, retrospective chart review, demographic and clinical data were collected on patients who had received the Altis® sling between 2014 and 2020. Descriptive statistics …

A Rare Case Of Pure N4-Acetyl-Sulfaethoxazole Nephrolithiasis Associated With Trimethoprim-Sulfamethoxazole Treatment Of Pulmonary Nocardiosis, Alexander Geisenhoff, Sugandh Shetty

Conference Presentation Abstracts

Introduction: Trimethoprim-sulfamethoxazole is a commonly used antibiotic for treatment of urinary tract infections (UTIs). It is also commonly used to treat nocardia infections. Less common are reports of nephrolithiasis consisting purely of N4-acetyl-sulfamethoxazole, the primary metabolite of trimethoprim-sulfamethoxazole. Case: A 70-year-old male with history of mantle cell lymphoma and T-cell leukemia treated with bone marrow transplant now with nocardia lung infection receiving trimethoprimsulfamethoxazole for the past 6 months who presented to the emergency room with confusion and a fall. He had no prior history of nephrolithiasis, but during hospitalization developed renal colic and was found to have obstructing right proximal …

A Novel Approach To Short Bulbar Urethral Strictures: Ventral Urethrotomy For A Non-Transection Excision And Primary Anastomosis, Alexander Geisenhoff, Samantha Kraemer, Frank Burks

Conference Presentation Abstracts

Introduction: Excision and primary anastomosis (EPA) has been the gold standard procedure for definitively managing short bulbar urethral strictures. A non-transecting approach was developed to help preserve proximal blood supply of the urethra. The previously described technique involves a dorsal urethrotomy and excision of the stricture without disrupting the anterior spongiosum. We describe a novel approach by performing a ventral urethrotomy leaving the posterior spongiosum intact. By not requiring urethral rotation, we believe this technique is simpler and does not compromise outcomes. Methods: Retrospective chart review was performed on 8 consecutive patients from April 2019 to February 2021 who underwent …

A Comparative Analysis Of Pelvic Fracture Urethral Injury Repairs In U.S. And Third World Country Patients, Jacob Stephens, Daniel Rosenstein, Frank Burks

Conference Presentation Abstracts

Introduction: Pelvic fracture urethral injury (PFUI) often results from significant, high energy trauma such as motor vehicle accidents or crush injuries. PFUI doesn’t spare those in third-world countries who may not have access to reliable healthcare. We aim to compare outcomes of PFUI repair in the US and third-world countries. Methods: A retrospective chart review and comparative analysis were performed on patients who had a PFUI repair during international trips to Haiti and Rwanda and a cohort of US patients from 2014-2020. FNB performed all US repairs while FB and DR collaborated internationally with local urologists. Results: A total of …

Acute Segmental Testicular Infarction Resulting From Illicit Anabolic Steroid Use, Jacob Stephens, Frank Burks

Conference Presentation Abstracts

Introduction: Segmental testicular infarction (STI) is a rare cause of acute scrotum of unknown etiology. The diagnosis is often made by color Doppler ultrasonography (CDUS) demonstrating absent perfusion in a well-defined testicular region. Previously patients underwent surgical exploration, but currently conservative therapy is recommended. Methods: We report a case of STI related to anabolic steroid use. Results: A 44-year-old male with a history of hypertension presented to the emergency room with acute, severe right testicular pain which was unprovoked and constant. Physical exam was notable only for tenderness at the inferior right testicle. CDUS showed small bilateral hydroceles but preserved …