Medical Specialties Commons^™

Febrile Young Infants Age <=60d With Covid-19 Infection: Review Of Clinical Presentation, Inflammatory Markers, Hospitalization Rate And Clinical Outcomes, Megumi T Mori, Tibisay Villalobos Md, Susan K. Yaeger Md, Claudia F. Busse Md

Department of Pediatrics

No abstract provided.

Using Multiple Imputation Of Real-World Data To Estimate Clinical Remission In Pediatric Inflammatory Bowel Disease, Nanhua Zhang, Chunyan Liu, Steven J. Steiner, Richard B. Colletti, Robert Baldassano, Shiran Chen, Stanley Cohen, Michael D. Kappelman, Shehzad Saeed, Laurie S. Conklin, Richard Strauss, Sheri Volger, Eileen King, Kim Hung Lo

Pediatrics Faculty Publications

Aim: To evaluate the performance of the multiple imputation (MI) method for estimating clinical effectiveness in pediatric Crohn's disease in the ImproveCareNow registry; to address the analytical challenge of missing data. Materials & methods: Simulation studies were performed by creating missing datasets based on fully observed data from patients with moderate-to-severe Crohn's disease treated with non-ustekinumab biologics. MI was used to impute sPCDAI remission statuses in each simulated dataset. Results: The true remission rate (75.1% [95% CI: 72.6%, 77.5%]) was underestimated without imputation (72.6% [71.8%, 73.3%]). With MI, the estimate was 74.8% (74.4%, 75.2%). Conclusion: MI reduced nonresponse bias and …

Acute Necrotizing Encephalopathy In An Infant: A Case Report, Elisamia Ngowi, Zeenat Juneja, Jacqueline Gabone, Maria Bulimba, Mohamedraza Ebrahim, Yaser Abdallah

Paediatrics and Child Health, East Africa

Background: Acute necrotizing encephalopathy is a rare, severe neurological condition, characterized by symmetrical necrotic brain lesions affecting the thalamus, cerebral white matter, brain stem, and cerebellum. Diagnosis relies on characteristic clinical and radiological features.

Methodology: We describe a 10-month-old female infant presenting with multiple seizures following a brief febrile upper respiratory illness.

Findings: MRI of the brain showed bilateral symmetrical abnormal signal intensities involving both thalami and caudate nucleus, consistent with ANE. Management of ANE is symptom-related but high-dose steroids and IVIG have been used.

Conclusion: This case highlights the importance of recognizing ANE beyond its …

Decs: A Tool For Systematic Cell Type Annotations Of Single-Cell Rna Sequencing Data Among Human Tissues, Guangsheng Pei, Fangfang Yan, Lukas M Simon, Yulin Dai, Peilin Jia, Zhongming Zhao

Faculty, Staff and Student Publications

Single-cell RNA sequencing (scRNA-seq) is revolutionizing the study of complex and dynamic cellular mechanisms. However, cell type annotation remains a main challenge as it largely relies on a priori knowledge and manual curation, which is cumbersome and subjective. The increasing number of scRNA-seq datasets, as well as numerous published genetic studies, has motivated us to build a comprehensive human cell type reference atlas.Here, we present decoding Cell type Specificity (deCS), an automatic cell type annotation method augmented by a comprehensive collection of human cell type expression profiles and marker genes. We used deCS to annotate scRNA-seq data from various tissue …

Exploring Modern Trends And Prevention Strategies For Childhood Obesity: A Comprehensive Literature Review, Anya E. Bogen

Honors Program: Senior Projects (Public)

This literature review seeks to provide an overview of the current research on childhood obesity. The study examines the prevalence and causes of childhood obesity, including genetic, environmental, and behavioral factors. The review also discusses the health consequences associated with childhood obesity, such as the increased risk for chronic diseases and psychological and social problems. Additionally, the review explores the effectiveness of interventions designed to prevent childhood obesity, including individual lifestyle modifications, education from health practitioners and school programs, and global, national, and state programs to promote wellness. The literature review concludes that childhood obesity is a complex and multifactorial …

Serotonin Reuptake Inhibitor Increases Pseudarthrosis Rates In Anterior Cervical Discectomy And Fusions, Mark J. Lambrechts, Nicholas D. D'Antonio, Gregory R R. Toci, Brian A. Karamian, Josuhu Pezzulo, Dominic Farronato, Jose Canseco, Ian David Kaye, Barrett Woods, Jeffrey A. Rihn, Mark Kurd, Joseph K. Lee, Md, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro, Gregory D. Schroeder

Rothman Institute Papers

STUDY DESIGN: Retrospective cohort.

PURPOSE: To determine (1) the effects of serotonin reuptake inhibitors in pseudarthrosis rates after anterior cervical decompression and fusion (ACDF) and (2) to identify patient-reported outcome measures in patients taking serotonin reuptake inhibitors.

OVERVIEW OF LITERATURE: Recent literature suggests that selective serotonin reuptake inhibitors (SSRIs) may inhibit fracture healing via downregulation of osteoblast differentiation. Spinal fusion supplementation with osteoblast-rich substances enhances spinal fusion, thus SSRIs may be detrimental.

METHODS: Patients with 1-year postoperative dynamic cervical spine radiographs following ACDF were grouped into serotonin reuptake inhibitor prescriptions (SSRI, serotonin-norepinephrine reuptake inhibitor [SNRI], or tricyclic antidepressant [TCA]) and …

Primary Care In Southern Illinois And Western Kentucky, Matthew J. Crabtree

Honors College Theses

There is a major physician shortage occurring across the United States as of 2023 and it is expected to get worse over the next five to ten years. A significant portion of the shortage is predicted to consist of primary care physicians in rural areas. Data on factors that affect primary care visits like rurality, household income, health insurance coverage, non-communicable disease, and primary care physician prevalence were analyzed from the regions of Southern Illinois and Western Kentucky. Health coverage was found to be average to above average in the two regions. However, almost all counties included in the study …

Accuracy Of Therapeutic Drug Monitoring In Vancomycin And The Pharmacist Role: A Retrospective Case-Series, Kateryna Parkhomenko

Senior Theses

Vancomycin is a mainstay of therapy for treating virulent and resistant infections, especially methicillin-resistant Staphylococcus aureus (MRSA). However, vancomycin requires therapeutic drug monitoring (TDM) for optimal dosing and treatment. This requires pharmacists to calculate a dosing regimen that correlates to appropriate goal vancomycin concentrations in the blood. Dosing vancomycin can be difficult, as it varies on a patient’s weight, renal function, age, etc. Doses may have to be adjusted in response to out-of-range concentrations, which requires further pharmacy calculations. Inaccurate dosing poses a risk to patient safety and places a resource and time burden on pharmacists. If vancomycin dosing methods …

A Comparison Of The Ways In Which The United States And European Nations Treat Chronic Kidney Disease, Robert W. Pokora Iii

Senior Theses

European nations and the United States of America have vastly different outcomes in their treatment of end-stage renal disease (ESRD) patients, specifically when considering survival rate and patient satisfaction level. Unfortunately, no study has ever detailed the reasons why this is the case. This thesis explores and compares the methods by which the United States and European nations treat chronic kidney disease (CKD) and ESRD patients. A literature review aimed to determine factors contributing to the varying outcomes between the two nations, and a Healthcare Provider Survey was crafted and administered to United States healthcare providers in order to determine …

Functional Status Among Patients With Established Copd Attending Tertiary Hospitals In Dar Es Salaam, Tanzania, Peter M. Tumbo

Master of Medicine in Internal Medicine

Background Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable non communicable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development. It is associated with a lot of risk factors such as smoking, biomass fuel use for cooking and air pollutants in general. Objectives The primary objective of this research was to determine the functional status of patients with COPD. The secondary objectives were to determine the factors influencing …

Post-Intensive Care Syndrome And Pulmonary Fibrosis In Patients Surviving Ards-Pneumonia Of Covid-19 And Non-Covid-19 Etiologies, Jamie L. Sturgill, Kirby Mayer, Anna G. Kalema, Kinjal Dave, Stephanie Mora, Alborz Kalantar, David J. Carter, Ashley A. Montgomery-Yates, Peter E. Morris

Markey Cancer Center Faculty Publications

The purpose was to examine patient‑centered outcomes and the occurrence of lung fibrotic changes on Chest computed tomography (CT) imaging following pneumonia‑related acute respiratory distress syndrome (ARDS). We sought to investigate outpatient clinic chest CT imaging in survivors of COVID19‑related ARDS and non‑COVID‑related ARDS, to determine group differences and explore relationships between lung fibrotic changes and functional outcomes. A retrospective practice analysis of electronic health records at an ICU Recovery Clinic in a tertiary academic medical center was performed in adult patients surviving ARDS due to COVID‑19 and non‑COVID etiologies. Ninety‑four patients with mean age 53 ± 13 and 51% …

Effect Of Exercise Training Intensity On Cognition, Jaclyn Voyt

Honors Projects

A literature review examining the effects of exercise intensity and modality on cognitive performance.

Innovative Management Of Posterior Upper Thigh Pain In Two Adolescent Athletes, Thomas Munro, Brian Harvey

Posters

Case history: Two 16-year-old males with posterior upper leg pain. Athlete A reports he had been exploding up to dunk a basketball when he felt a pop with immediate pain in his posterior LLE. He was treated conservatively with activity modification and PT resulting in improvement of symptoms and return to full activity. He returned 15-months after the initial injury due to recurrence of pain. Athlete B stated he had tweaked his hamstring multiple times over the summer and had been working with a physical therapist for rehabilitation. He had attempted full rest for a couple weeks with graded return …

A Metabolic, Mechanical, Multi-Organ Masterpiece: Dural Device Support Bridge To En-Bloc Heart-Liver Transplantation In Propionic Acidemia, Rebecca Juhl, Brian Birnbaum, Aliessa P. Barnes, William Gibson, Bhargava Mullapudi, Beth Lang, Megan Faseler, Daniel E. Heble, Victoria Urban, Ryan T. Fischer, Jennifer L. Gannon, David Sutcliffe

Posters

Introduction: Propionic Acidemia (PA) is a disorder related to abnormal protein and lipid metabolism resulting in progressive neurological injury and dilated cardiomyopathy (DCM). Interventions for PA and secondary disease manifestations can require multi-organ transplantation. Herein we report the case of a child with PA and end-stage DCM requiring left ventricular assist device (LVAD) support with eventual heart-liver transplant. Case Report: A 17 year old male diagnosed in childhood with PA developed chronically progressive DCM culminating in end stage heart failure with acute decompensations. In a recurrent admission, he progressed to require dual inotropic support and systemic anticoagulation for new LV …

A Physician's Most Important Teachers, Rachel Pray

be Still

I hope to never lose sight of the reasons why I became a physician: to make deep, real connections with patients while they may be going through one of the worst or most uncertain time of their lives - offering comfort and expertise to ease their worries - and to assist them in becoming the best, healthiest, happiest versions of themselves. Remembering my "why" has helped me overcome the struggles and trials of medical school, and I will continue to hold it close to me throughout my medical career.

2023 Research Day Program, Lincoln Memorial University

Research Day

This program contains abstracts and presentation summaries from LMU's 2023 Annual Research Day conference.

Health Consequences Of Low Energy Availability In Females And Their Underlying Physiological Mechanisms, Grace Parry

Senior Honors Theses

Low energy availability (LEA) is a state in which energy intake is insufficient to support energy expenditure while maintaining energy balance, which has been shown to result in gastrointestinal distress, immunosuppression, reduced metabolic rate, menstrual dysfunction, diminished bone health, and impaired cardiovascular function in females. Alterations to the microbiome and mucosal lining may propagate gastrointestinal complaints and compromised immune function associated with LEA. The pathophysiology of LEA is otherwise largely driven by hormonal adaptations. Diminished production of thyroid hormones is known to contribute to reduced metabolic rate. Decreases in leptin and insulin and increases in ghrelin disrupt reproductive function through …

Iv Dexamethasone To Assist With Post Operative Pain And Nausea, Tasha Coumbs

Articles, Abstracts, and Reports

No abstract provided.

Minds For Hearts - A Targeted Education Project Focused On Cardiovascular Health In The Psychiatric Community, Peter Franz, Anisha Boetel

Articles, Abstracts, and Reports

No abstract provided.

Optimized Acute Treatment Of Migraine Is Associated With Greater Productivity In People With Migraine: Results From The Chronic Migraine Epidemiology And Outcomes (Cameo) Study., Dawn C Buse, Stephanie J. Nahas, Walter Buzz F Stewart, Cynthia E Armand, Michael L Reed, Kristina M Fanning, Aubrey Manack Adams, Richard B Lipton

Department of Neurology Faculty Papers

OBJECTIVE: This study aimed to ascertain whether level of optimization of acute treatment of migraine is related to work productivity across the spectrum of migraine.

METHODS: Data were from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, an internet-based longitudinal survey. Respondents with migraine who reported full-time employment and use of ≥1 acute prescription medication for migraine were included. We determined relationships among lost productive time (LPT; measured with the Migraine Disability Assessment Scale), acute treatment optimization (Migraine Treatment Optimization Questionnaire- ), and monthly headache days (MHDs).

RESULTS: There was a direct relationship between LPT and MHD category. Greater acute …

Berberine Disrupts Staphylococcal Proton Motive Force To Cause Potent Anti-Staphylococcal Effects, Neil Zhao, Selin Isguven, Rachel Evans, Thomas P Schaer, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

The presence of antibiotic resistance has increased the urgency for more effective treatments of bacterial infections. Biofilm formation has complicated this issue as biofilm bacteria become tolerant to antibiotics due to environmental factors such as nutrient deprivation and adhesion. In septic arthritis, a disease with an 11% mortality rate, bacteria in synovial fluid organize into floating, protein-rich, bacterial aggregates (mm-cm) that display depressed metabolism and antibiotic tolerance. In this study, Staphylococcus aureus (S. aureus), which is the most common pathogen in septic arthritis, was tested against different inhibitors that modulate bacterial surface protein availability and that should decrease bacterial aggregation. …

Prehospital Shock Index Predicts Outcomes After Prolonged Transport: A Multicenter Rural Study., James M Bardes, Bradley S Price, Hannah Bailey, Alexander Quinn, Zachary D Warriner, Andrew C Bernard, Aimee Lariccia, M Chance Spalding, Melissa B Linskey Dougherty, Scott B Armen, Alison Wilson

Trauma and Acute Care Articles

BACKGROUND: Shock index (SI) predicts outcomes after trauma. Prior single-center work demonstrated that emergency medical services (EMSs) initial SI was the most accurate predictor of hospital outcomes in a rural environment. This study aimed to evaluate the predictive ability of SI in multiple rural trauma systems with prolonged transport times to a definitive care facility.

METHODS: This retrospective review was performed at four American College of Surgeons-verified level 1 trauma centers with large rural catchment basins. Adult trauma patients who were transferred and arrived >60 minutes from scene during 2018 were included. Patients who sustained blunt chest or abdominal trauma …

An Untrained Deep Learning Method For Reconstructing Dynamic Mr Images From Accelerated Model-Based Data, Kalina P Slavkova, Julie C Dicarlo, Viraj Wadhwa, Sidharth Kumar, Chengyue Wu, John Virostko, Thomas E Yankeelov, Jonathan I Tamir

Faculty, Staff and Student Publications

PURPOSE: To implement physics-based regularization as a stopping condition in tuning an untrained deep neural network for reconstructing MR images from accelerated data.

METHODS: The ConvDecoder (CD) neural network was trained with a physics-based regularization term incorporating the spoiled gradient echo equation that describes variable-flip angle data. Fully-sampled variable-flip angle k-space data were retrospectively accelerated by factors of R = {8, 12, 18, 36} and reconstructed with CD, CD with the proposed regularization (CD + r), locally low-rank (LR) reconstruction, and compressed sensing with L1-wavelet regularization (L1). Final images from CD + r training were evaluated at the "argmin" of …

Causal Effects On Complex Traits Are Similar For Common Variants Across Segments Of Different Continental Ancestries Within Admixed Individuals, Kangcheng Hou, Yi Ding, Ziqi Xu, Yue Wu, Arjun Bhattacharya, Rachel Mester, Gillian M Belbin, Steve Buyske, David V Conti, Burcu F Darst, Myriam Fornage, Chris Gignoux, Xiuqing Guo, Christopher Haiman, Eimear E Kenny, Michelle Kim, Charles Kooperberg, Leslie Lange, Ani Manichaikul, Kari E North, Ulrike Peters, Laura J Rasmussen-Torvik, Stephen S Rich, Jerome I Rotter, Heather E Wheeler, Genevieve L Wojcik, Ying Zhou, Sriram Sankararaman, Bogdan Pasaniuc

Faculty, Staff and Student Publications

Individuals of admixed ancestries (for example, African Americans) inherit a mosaic of ancestry segments (local ancestry) originating from multiple continental ancestral populations. This offers the unique opportunity of investigating the similarity of genetic effects on traits across ancestries within the same population. Here we introduce an approach to estimate correlation of causal genetic effects (radmix) across local ancestries and analyze 38 complex traits in African-European admixed individuals (N = 53,001) to observe very high correlations (meta-analysis radmix = 0.95, 95% credible interval 0.93-0.97), much higher than correlation of causal effects across continental ancestries. We replicate our results using regression-based methods …

Consensus-Based Evaluation Of Outcome Measures In Pediatric Stroke Care: A Toolkit, Samantha J Feldman, Lauren A Beslow, Ryan J Felling, Laura A Malone, Michaela Waak, Stuart Fraser, Nihal Bakeer, Jo Ellen M Lee, Victoria Sherman, Melissa M Howard, Beth Anne Cavanaugh, Robyn Westmacott, Lori C Jordan

Faculty, Staff and Student Publications

Following a pediatric stroke, outcome measures selected for monitoring functional recovery and development vary widely. We sought to develop a toolkit of outcome measures that are currently available to clinicians, possess strong psychometric properties, and are feasible for use within clinical settings. A multidisciplinary group of clinicians and scientists from the International Pediatric Stroke Organization comprehensively reviewed the quality of measures in multiple domains described in pediatric stroke populations including global performance, motor and cognitive function, language, quality of life, and behavior and adaptive functioning. The quality of each measure was evaluated using guidelines focused on responsiveness and sensitivity, reliability, …

Quantification Of The Role Of Lead Foil In Flattening Filter Free Beam Reference Dosimetry, Song Gao, Christopher Nelson, Congjun Wang, Vindu Kathriarachchi, Michael Choi, Rishik Saxena, Robin Kendall, Peter Balter

Faculty, Staff and Student Publications

PURPOSE: To quantify the potential error in outputs for flattening filter free (FFF) beams associated with use of a lead foil in beam quality determination per the addendum protocol for TG-51, we examined differences in measurements of the beam quality conversion factor k

METHODS: Two FFF beams, a 6 MV FFF and a 10 MV FFF, were calibrated on eight Varian TrueBeams and two Elekta Versa HD linear accelerators (linacs) according to the TG-51 addendum protocol by using Farmer ionization chambers [TN 30013 (PTW) and SNC600c (Sun Nuclear)] with traceable absorbed dose-to-water calibrations. In determining k

RESULTS: Differences in %dd(10)x …

Model-Constrained Reconstruction Accelerated With Fourier-Based Undersampling For Hyperpolarized [1-13c] Pyruvate Imaging, Zhan Xu, Keith A Michel, Christopher M Walker, Collin J Harlan, Gary V Martinez, Jeremy W Gordon, Hsin-Yu Chen, Daniel B Vigneron, James A Bankson

Faculty, Staff and Student Publications

PURPOSE: Model-constrained reconstruction with Fourier-based undersampling (MoReFUn) is introduced to accelerate the acquisition of dynamic MRI using hyperpolarized [1-

METHODS: The MoReFUn method resolves spatial aliasing using constraints introduced by a pharmacokinetic model that describes the signal evolution of both pyruvate and lactate. Acceleration was evaluated on three single-channel data sets: a numerical digital phantom that is used to validate the accuracy of reconstruction and model parameter restoration under various SNR and undersampling ratios, prospectively and retrospectively sampled data of an in vitro dynamic multispectral phantom, and retrospectively undersampled imaging data from a prostate cancer patient to test the fidelity …

Enoxaparin May Be Associated With Lower Rates Of Mortality Than Unfractionated Heparin In Neurocritical And Surgical Patients, Sophie Samuel, Catherine To, Yaobin Ling, Kai Zhang, Xiaoqian Jiang, Elmer V Bernstam

Faculty, Staff and Student Publications

Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are often administered to prevent venous thromboembolism (VTE) in critically ill patients. However, the preferred prophylactic agent (UFH or LMWH) is not known. We compared the all-cause mortality rate in patients receiving UFH to LMWH for VTE prophylaxis. We conducted a retrospective propensity score adjusted analysis of patients admitted to neuro-critical, surgical, or medical intensive care units. Patients were included if they were screened with venous duplex ultrasonography or computed tomography angiography for detection of VTE. The primary outcome was all-cause mortality. Secondary outcomes included the prevalence of VTE, deep vein …

Convolutional Neural Network For Biomarker Discovery For Triple Negative Breast Cancer With Rna Sequencing Data, Xiangning Chen, Justin M Balko, Fei Ling, Yabin Jin, Anneliese Gonzalez, Zhongming Zhao, Jingchun Chen

Faculty, Staff and Student Publications

Triple negative breast cancers (TNBCs) are tumors with a poor treatment response and prognosis. In this study, we propose a new approach, candidate extraction from convolutional neural network (CNN) elements (CECE), for discovery of biomarkers for TNBCs. We used the GSE96058 and GSE81538 datasets to build a CNN model to classify TNBCs and non-TNBCs and used the model to make TNBC predictions for two additional datasets, the cancer genome atlas (TCGA) breast cancer RNA sequencing data and the data from Fudan University Shanghai Cancer Center (FUSCC). Using correctly predicted TNBCs from the GSE96058 and TCGA datasets, we calculated saliency maps …

In Vitro Activity Of Eravacycline And Comparator Agents Against Bacterial Pathogens Isolated From Patients With Cancer, Kenneth Rolston, Bahgat Gerges, Lior Nesher, Samuel A Shelburne, Randall Prince, Issam Raad

Faculty, Staff and Student Publications

BACKGROUND: Bacterial infections are common in patients with cancer, and many bacteria have developed resistance to currently used antibiotics.

OBJECTIVES: We evaluated the

METHODS: Antimicrobial susceptibility testing was performed using CLSI-approved methodology and interpretive criteria for 255 Gram-positive and 310 Gram-negative bacteria. MIC and susceptibility percentage were calculated according to CLSI and FDA breakpoints when available.

RESULTS: Eravacycline had potent activity against most Gram-positive bacteria, including MRSA. Of 80 Gram-positive isolates with available breakpoints, 74 (92.5%) were susceptible to eravacycline. Eravacycline had potent activity against most Enterobacterales, including ESBL-producing organisms. Of 230 Gram-negative isolates with available breakpoints, 201 (87.4%) were …