Medical Specialties Commons^™

Hearing Health And Dementia - Authors' Reply, Dongshan Zhu, Shiva Raj Mishra, Salim S. Virani, Nipun Shrestha, Fan Jiang

Office of the Provost

No abstract provided.

Multilevel Community Engagement To Inform A Randomized Clinical Trial, Kirby L. Wycoff, Jabina G. Coleman, Christine M. Santoro, Leah L. Zullig, Niesha Darden, Porsche M. Holland, Jane F. Cruice, Shukriyyah Mitchell, Michelle Smith, Saleemah J. Mcneil, Sharon J. Herring

Counseling and Behavioral Health Faculty Papers

OBJECTIVE: To explore how patients, community-based perinatal support professionals, and health system clinicians and staff perceived facilitators and barriers to implementation of a randomized clinical trial (RCT) designed to optimize Black maternal heart health.

METHODS: This article describes the formative work that we believed needed to occur before the start of the Change of H.E.A.R.T (Here for Equity, Advocacy, Reflection and Transformation) RCT. We used a qualitative, descriptive design and community-based, participatory approach, the latter of which allowed our team to intentionally focus on avoiding harm and equalizing power dynamics throughout the research process. Data were collected between November 2021 …

Should We Use Rifampicin In Periprosthetic Joint Infections Caused By Staphylococci When The Implant Has Been Exchanged? A Multicenter Observational Cohort Study, Tobias Siegfried Kramer, Alex Soriano, Sarah Tedeschi, Antonia F. Chen, Pierre Tattevin, Eric Senneville, Joan Gomez-Junyent, Victoria Birlutiu, Sabine Petersdorf, Vicens Diaz De Brito, Ignacio Sancho Gonzalez, Katherine A. Belden, Marjan Wouthuyzen-Bakker

Division of Infectious Diseases and Environmental Medicine Faculty Papers

BACKGROUND: Previous studies demonstrated the efficacy of a rifampicin-based regimen in the treatment of acute staphylococcal periprosthetic joint infections (PJIs) treated with surgical debridement. However, evidence is lacking to support the use of rifampicin in cases where the implant is exchanged during revision.

METHODS: We included all consecutive cases of staphylococcal PJIs treated from January 2013 to December 2018 with revision surgery in this international, retrospective, multicenter observational cohort study. PJI was defined according to the European Bone and Joint Infection Society diagnostic criteria. A relapse or reinfection during follow-up, the need for antibiotic suppressive therapy, the need for implant …

Mothers Get Really Exhausted!” The Lived Experience Of Pregnancy In Extreme Heat: Qualitative Findings From Kilifi, Kenya, Fiona Scorgie, Adelaide Lusambili, S. Luchters, Peter. Khaemba, Veronique Filippi, B. Nakstad, Jeremy Hess, Cathryn Birch, S. Kovats, M.F. Chersich

Institute for Human Development, East Africa

Background: Palliative care (PC) can reduce symptom distress and improve quality of life for patients and their families experiencing life-threatening illness. While the need for PC in Kenya is high, PC service delivery and research is limited. Qualitative research is needed to explore potential areas for PC research and support needed to enable that research. This insight is critical for informing a national PC research agenda and mobilizing limited resources for conducting rigorous PC research in Kenya.

Objectives: To explore perceptions of priority areas for PC research and support needed to facilitate rigorous research from the perspective of Kenyan PC …

Sexual Risk-Taking Behavior Amongst Emerging Adults In A Tertiary Institution Of Learning In Coastal Kenya: A Qualitative Study Of Stakeholders’ Perspectives Using Causal Loop Mapping, Stevenson K. Chea, Vincent A. Kagonya, Eunice A. Oyugi, Carophine Nasambu, Isaac Menza, Fauz Ibrahim, Osman Abdullahi, Alice Anika, Amin S. Hassan, Amina Abubakar

Institute for Human Development, East Africa

Background It is known from previous studies that university students in sub-Saharan Africa (sSA) engage in sexual risk-taking behaviour (SRTB). However, there is paucity of data on factors contributing to SRTB among university students (emerging adults) at the Kenyan Coast thus hindering intervention planning. This study seeks to provide an in-depth qualitative understanding of the factors contributing to SRTB and their interconnectedness among university students at the Kenyan Coast combining qualitative research with a systems thinking approach.

Methods Using the ecological model, and employing in-depth interviews, we explored the perceptions of twenty-six key informants (twenty-one emerging adults and five other …

Sangrado Del Tubo Digestivo Alto Secundario A Infección De Adenovirus, Moises Alatorre-Jimenez, Sarah T. Edwards, Thomas M. Attard

Posters

Titulo: Sangrado del Tubo Digestivo Alto Secundario a Infección de Adenovirus Introducción: El Sangrado del tubo digestivo alto (STDA) es causado por múltiples etiologías incluyendo gastritis, varices, esofagitis, anomalidades vasculares, cuerpos extraños, y ulceras (1). Dentro de estas causas se conoce que infecciones virales pueden producir ulceras causando sangrado los más comunes son el virus de Epstein- Barr, Covid-19, Herpesvirus-6, Herpesvirus-7 y Citomegalovirus (1,2,3,4,5). Presentamos el caso de un paciente con STDA severo a causa de infección por adenovirus. Reporte de Caso: Paciente de 22 meses de edad, previamente sano que se presenta al servicio de Urgencias debido a un …

Factors Associated With Respiratory Pathogen Panel Utilization In Children Hospitalized With Acute Respiratory Illness — New Vaccine Surveillance Network, Kansas City, 2017–2021, Edward Lyon, Brian R. Lee, Benjamin Clopper, Heidi L. Moline, Rangaraj Selvarangan, Jennifer Schuster

Posters

Background: Respiratory pathogen panels (RPP) are multiplex PCR platforms that detect several respiratory viruses from one specimen. For most children hospitalized with acute respiratory illness (ARI), management is supportive, and detection of a specific virus from RPP does not impact clinical care. Therefore, clinical RPP use is not standardized, and ordering is at the discretion of the clinician. We sought to understand factors associated with RPP utilization among pediatric patients hospitalized with ARI. Methods: From October 2017 to September 2021, participants < 18 years hospitalized with ARI were enrolled at a single site in the New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, MO, had one or more ARI symptoms (e.g., cough, fever, nasal congestion) lasting < 14 days, and were enrolled within 48 hours of admission. Parent interviews and medical chart reviews were conducted. All participants had a research RPP, but results were not available to the clinical providers. Clinical providers were able to order a clinical RPP (cRPP), for which they received test results. Characteristics of NVSN enrollees hospitalized with ARI with and without a cRPP are described. Lastly, medical complexity was assessed via the pediatric complex chronic conditions classification system (CCC) then analyzed via chi- square test between groups. Findings: During the study period, 1,038 participants were enrolled, and 555 (53.4%) received a cRPP. Most, 299 (53%), cRPPs were ordered in the emergency department or urgent care before admission. Age was a significant factor associated with cRPP use (Table 1). cRPP participants were more likely to have complex chronic conditions, and/or technology dependence. No difference in cRPP use was observed by race/ethnicity, payer status, or sex. More participants were enrolled in 2020-2021, but the overall usage of cRPP is similar between years (Table 2). Conclusions: In this large cohort of children hospitalized with ARI, medical complexity, technological dependence, and age < 2 months were associated with increased utilization of cRPPs. Understanding the impact of cRPP on clinical care requires further investigation to better understand the utility of these tests.

Dexamethasone For Bpd While On Non-Invasive Positive Pressure Ventilation, Priya Tiwari, Jansynn Radford, Michael Norberg, Alain Cuna

Posters

Background: Postnatal dexamethasone (DEX) has traditionally been reserved for preterm infants on prolonged mechanical ventilation, with reported rates of successful extubation at 47% to 76%. Recent emphasis on avoiding mechanical ventilation has resulted in preterm infants being increasingly supported with chronic non-invasive ventilation (NIV). The use of DEX for weaning preterm infants on chronic NIV remains largely unexplored. Objective: To determine efficacy of postnatal DEX in weaning infants on chronic NIV, and to identify factors and outcomes associated with successful weaning. Methods: Single-center retrospective study (2010-2022) of preterm infants ≤32 weeks gestation treated with postnatal DEX while on chronic NIV. …

Inflammasome Activation And Pyroptosis Mediate Coagulopathy And Inflammation In Salmonella Systemic Infection, Ankit Pandeya, Yan Zhang, Jian Cui, Ling Yang, Jeffery Li, Guoying Zhang, Congqing Wu, Zhenyu Li, Yinan Wei

Saha Cardiovascular Research Center Faculty Publications

Inflammasome activation is a critical defense mechanism against bacterial infection. Previous studies suggest that inflammasome activation protects against Salmonella oral infection. Here we find inflammasome activation plays a critical role in the pathogenesis of Salmonella systemic infection. We show that in a systemic infection model by i.p. injection of Salmonella, deficiency of caspase-1 or gasdermin-D prolonged survival time, reduced plasma concentrations of the proinflammatory cytokines IL-1β, IL-6 and TNFα. These deficiencies also protected against coagulopathy during Salmonella infection as evidenced by diminished prolongation of prothrombin time and increase in plasma thrombin-antithrombin complex concentrations in the caspase-1 or gasdermin-D deficient mice. …

Exaggerated Cutaneous Responses In Patients With Hematologic Malignancy, Trang Nguyen, Christina E. Borchers, Julian Trevino

Dermatology Faculty Publications

Eosinophilic dermatosis of hematologic malignancy (EDHM) is a cutaneous manifestation rarely seen in Chronic lymphocytic leukemia (CLL) and chronic myelomonocytic leukemia (CMML). EDHM, first described in 19651, is identified by treatment-resistant pruritic papules, eosinophil-rich dermal lymphohistiocytic infiltrate, exclusion of other causes of tissue eosinophilia, and preexisting diagnosis of hematologic malignancy2. Similarly, arthropod hypersensitivity reactions, or insect bite hypersensitivity, also cause significant discomfort and morbidity in individuals with hematologic malignancies. Proposed treatments exist, but assessing exaggerated skin reactions as prognostic markers requires further study. We outline two clinical cases illustrating the potential spectrum of EDHM encounters.

Pulmonary & Critical Care Insider: Issue 3, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 3

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.

Summaries/Topics in this issue:

Lactated Ringer's or Normal Saline in Acute Pancreatitis?

Don’t complain about too many CT scans being ordered by your ED doctor!

Stroke care for intensivists – Not as complicated after …

Program Development Of Incorporating Mindfulness-Based Practices Within Pediatric Occupational Therapy, Sarah Cottone, Zeida Gutierrez, Katie O'Hara

Fall 2023 Virtual OTD Capstone Symposium

This capstone project will address the limited literature and provide treatment results on the effective use of mindfulness exercises in pediatric occupational therapy for improved self-regulation. Purpose: This program aims to educate the pediatric clinic on the benefits of mindfulness and to develop mindfulness-based exercises to implement within pediatric occupational therapy sessions for self-regulation treatments. The purpose of the mindfulness exercises was to show efficient, effective, and noninvasive approaches to regulate a child’s emotions and sensory system.

Sickle Cell Disease: Management Of Acute Pain, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Rumination Syndrome Diagnosis Supported By Colon Manometry In A Pediatric Patient, Alex Biller, John Rosen, Amornluck Krasaelap

Posters

Introduction: Rumination syndrome is a disorder of gut-brain interaction characterized by effortless repetitive postprandial regurgitation, reswallowing, and/or spitting.(1) This condition is caused by increased intragastric pressure due to abdominal muscle contractions, leading to the opening of the lower esophageal sphincter and the return of gastric content into the esophagus.(1) Rumination is a clinical diagnosis after the exclusion of other etiologies of symptoms. The diagnosis of rumination is clinical, but supportive evidence can be obtained through esophageal or antroduodenal manometry.(2) We present a unique case report of rumination syndrome diagnosis supported by data obtained during colon manometry in a pediatric patient. …

Oscillometry In Term Neonates Without Respiratory Disease, Anna Nelson, Cheri Gauldin, Brooke Smith, Venkatesh Sampath, Winston M. Manimtim

Posters

Background Bronchopulmonary dysplasia (BPD) is one of the most common complications of prematurity. While severity of BPD is defined by need and type of respiratory support at 36 weeks, it does not distinguish between endotypes of disease. Recent studies suggest that infants with severe BPD have parenchymal, airway and pulmonary vascular disease. Determining the BPD phenotype could help guide future individualized therapy. Oscillometry is a bedside tool that measures the resistance of the airways and the reactance of the pulmonary parenchyma. Normative values of oscillometry need to be established to serve as a comparison prior to establishing oscillometry characteristics of …

Increasing The Rate Of Infants Rooming In With Their Mothers With Low Acuity Congenital Heart Disease, Anna Nelson, Amy Marks, Ekta Patel

Posters

Background The Children’s Mercy Fetal Health Center (FHC) was created to be able to deliver infants with complex fetal diagnoses including congenital heart disease. Mothers are referred from all over the Midwest region for their babies to have access to specialized care immediately after birth. Nearly all babies born in the FHC are admitted to our neonatal intensive care unit (NICU), as there are not well-established guidelines for keeping babies with their mothers if they have low-risk congenital heart disease that do not need intensive care continuous monitoring. Maternal infant bonding starts before an infant is born and becomes stronger …

Socio-Economic Factors And Its Influence On The Association Between Temperature And Dengue Incidence In 61 Provinces Of The Philippines, 2010–2019, Xerxes Seposo, Sary Valenzuela, Geminn Louis Apostol

Ateneo School of Medicine and Public Health Publications

Background

Temperature has a significant impact on dengue incidence, however, changes on the temperature-dengue relationship across axes of socio-economic vulnerability is not well described. This study sought to determine the association between dengue and temperature in multiple locations in the Philippines and explore the effect modification by socio-economic factors.

Method

Nationwide dengue cases per province from 2010 to 2019 and data on temperature were obtained from the Philippines’ Department of Health–Epidemiological Bureau and ERA5-land, respectively. A generalized additive mixed model (GAMM) with a distributed lag non-linear model was utilized to examine the association between temperature and dengue inci-dence. We further …

Low-Risk Fever And Neutropenia, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

A Reflection Of Experiences Of Adults With Type 1 Diabetes In Integrated Physical Education Classes, Kalleigh West

Human Movement Studies & Special Education Theses & Dissertations

The purpose of this study was to gain an understanding of the experiences of type 1 diabetics in integrated physical education classes. In this study, we interviewed young type 1 diabetic adults and asked them to reflect on their school-based physical education experiences. An interpretative phenomenological analysis (IPA) approach was adopted to guide data collection, analysis, and interpretation for this retrospective study. Eight participants (ages 19 to 32) were enrolled in this study, and semi-structured interviews focused on their physical education experiences acted as the primary data. Transcribed interview data were analyzed using an IPA approach. Three interrelated themes emerged …

Structural Insights Into The Cl-Par-4 Protein: Ionic Requirements, Conformational Transitions, And Interaction With Cisplatin, Krishna Kumar Raut

Chemistry & Biochemistry Theses & Dissertations

Cancer continues to be the leading global cause of death, with challenges in early diagnosis, drug resistance, non-specific drug targeting, and cancer recurrence and metastasis posing formidable obstacles in cancer therapy. In this context, Prostate Apoptosis Response-4 (Par-4), a pro-apoptotic tumor suppressor protein, emerged as a promising therapeutic target due to its ability to selectively induce apoptosis in cancer cells, thereby minimizing the drug-associated adverse effects. However, a comprehensive understanding of the structural features of Par-4, specifically the caspase-cleaved fragment (cl-Par-4), is crucial for therapeutic advancements.

This dissertation investigated the effects of various ions, both monovalent and divalent, on the …

The Diagnostic Process Of Spinal Post-Traumatic Deformity: An Expert Survey Of 7 Cases, Consensus On Clinical Relevance Does Exist, Erin E.A. De Gendt, Lori M. Benneker, Andrei F. Joaquim, Mohammad El-Sharkawi, Gaurav R. Dhakal, Frank Kandziora, Jin Tee, Richard J. Bransford, Emiliano N. Vialle, Alexander R. Vaccaro, Eugen C. Popescu, Rishi M. Kanna, David W. Polly, Klaus J. Schnake, Pedro Berjano, Sergey Ryabykh, Marko Neva, Claudio Lamartina, Dominique A Rothenfluh, Stephan J. Lewis, Sander. P.J Muijs, F. Cumhur Oner

Rothman Institute Papers

STUDY DESIGN: Survey of cases.

OBJECTIVE: To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD).

SUMMARY OF BACKGROUND DATA: SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment. The question of when SPTD becomes clinically relevant is yet to be resolved.

METHODS: The survey of 7 cases was sent to 31 experts. The case presentation was medical history, diagnostic assessment, evaluation of diagnostic assessment, diagnosis, and treatment options. Means, ranges, percentages of participants, and descriptive statistics were calculated.

RESULTS: Seventeen spinal surgeons reviewed …

Disentangling Sex Differences In Ptsd Risk Factors: A Systematic Overview And Multiple Mediation Analysis The The Aurora Study, Stephanie Haering, Antonia V. Seligowski, Sarah Linnstaedt, Vasiliki Michopoulos, Stacey L. House, Francesca Beaudoin, Xinming An, Thomas C. Neylan, Gari Clifford, Robert A. Swor

Articles

No abstract provided.

The Implementation Of A Pectus Bar Insertion Eras Pathway, Todd A. Glenski, Emily Weisberg, Christian M. Taylor, Brandon Layton, Andrea Melanson, Sameer Lalani

Posters

No abstract provided.

Candida Chorioretinitis In Immunocompromised Patient With Candida Tropicalis Fungemia Secondary To Chemotherapy, Jourdan Valkner Krause

Posters

Summary: An immunocompromised patient with candida tropicalis fungemia secondary to chemotherapy presented for follow up of candida chorioretinitis. This infection puts the patient at high risk for CNVM formation and must be followed closely. Case History: • 3-year-old Hispanic female • CC: Candida chorioretinitis follow up • POH: Bilateral orbital chloromas and optic nerve atrophy • PMH: Acute myeloid leukemia, Candida tropicalis fungemia • Meds: o Amphotericin B liposomal 85 mg 42.5 mL, IV, q24hr o Flucytosine 500 mg Capsule *NF* 1,000 mg 2 capsule, PO/NG, q6hr o Micafungin 100 mg 100 mL, IV, q24hr *Plus numerous chemotherapy, pain and …

Assessment Of Portal System Hemodynamics For The Prediction Of Portal-Vein Thrombosis In Cirrhosis - A Systematic Review And Meta-Analysis, Marko Kozyk, Suprabhat Giri, Ankita Singh, Kailash Kolhe, Akash Roy, Kateryna Strubchevska

Conference Presentation Abstracts

Background: The pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present systematic review was conducted to study the role of assessment of portal hemodynamics for the prediction of PVT in patients with cirrhosis. Methods: Three databases (Medline, Embase, and Scopus) were searched from inception to February 2023 for studies comparing portal venous system parameters in patients with cirrhosis developing PVT with those not. Results were presented as mean difference (MD) or odds ratio (OR) with their 95% confidence intervals (CI). Results: A total of 31 studies (patients with …

Deletion Of Interleukin-17a Augments Portal Fibrosis In A Mouse Model Of Cholestatic Liver Injury, Takashi Kitagataya, Kirsta Olson, Michelle Baez-Faria, Nazli Begum Ozturk, Kaiyel Cutshaw, Anuradha Krshnan, Maria Eugenia Guicciardi, Kevin D. Pavelko, Gregory J. Gores

Conference Presentation Abstracts

Background: The underlying mechanism contributing to cholestatic liver injury remains unclear. The proinflammatory cytokine interleukin-17A (IL-17A) has been implicated in human cholestatic liver injury. However, mechanistic insights on how IL-17A modulates cholestatic liver injury are lacking and require further exploration in preclinical models. Herein, we examined the effects of IL-17A genetic deletion in a mouse model of cholestasis. Methods: Ageand gender-matched littermate WT and Il-17a-/- were fed intermittently on 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet or control diet (n=10, each) and standard diet for 21 days to induce cholestatic liver injury. We assessed liver inflammation, ductular reaction, and fibrosis using complementary approaches. …

Activated Protein C, Protein S, And Tissue Factor Pathway Inhibitor Cooperate To Inhibit Thrombin Activation, Xian Li, Xiaohong Song, Dlovan F. D. Mahmood, Martha M. S. Sim, Sara J. Bidarian, Jeremy P. Wood

Saha Cardiovascular Research Center Faculty Publications

Introduction: Thrombin, the enzyme which converts fibrinogen into a fibrin clot, is produced by the prothrombinase complex, composed of factor Xa (FXa) and factor Va (FVa). Down-regulation of this process is critical, as excess thrombin can lead to life-threatening thrombotic events. FXa and FVa are inhibited by the anticoagulants tissue factor pathway inhibitor alpha (TFPIα) and activated protein C (APC), respectively, and their common cofactor protein S (PS). However, prothrombinase is resistant to either of these inhibitory systems in isolation. Materials and methods: We hypothesized that these anticoagulants function best together, and tested this hypothesis using purified proteins and plasma-based …

Novel Strategies In Antithrombotic Therapy: Targeting Thrombosis While Preserving Hemostasis, Martha M. S. Sim, Semekidus Shiferawe, Jeremy P. Wood

Saha Cardiovascular Research Center Faculty Publications

Antithrombotic therapy is a delicate balance between the benefits of preventing a thrombotic event and the risks of inducing a major bleed. Traditional approaches have included antiplatelet and anticoagulant medications, require careful dosing and monitoring, and all carry some risk of bleeding. In recent years, several new targets have been identified, both in the platelet and coagulation systems, which may mitigate this bleeding risk. In this review, we briefly describe the current state of antithrombotic therapy, and then present a detailed discussion of the new generation of drugs that are being developed to target more safely existing or newly identified …

Teaching And Tomorrow: Children's Mercy Hospital Pediatric Gastroenterology Fellowship Program, Children's Mercy Kansas City

Posters

No abstract provided.

Anesthetic Management Of Clamshell Thoracotomy For Large Tumor, Kasey Brooks, Nathaniel Lata

Posters

No abstract provided.