Medical Specialties Commons^™

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Non-Alcoholic Pancreatic Lipomatosis Among The Egyptian Type 2 Diabetic Patients, Abdel-Rahman Mahrous, Mohammed Noshy Al-Alfy, Mohammed Abdel-Hassib, Mohammed A. Amin

Al-Azhar International Medical Journal

Background: Obesity has become a serious public health problem globally. Non-alcoholic pancreatic lipomatosis is characterized by pancreatic fat infiltration or pancreatic islet steatosis resulting in abnormal adipokine secretion, insulin resistance, impaired βcell function, and decreased insulin secretion.

Aim: To assess the relationship between non-alcoholic fatty pancreatic disease and type 2 diabetes mellitus among Egyptian patients.

Methods: We enrolled 80 type 2 diabetic patients along with 80 healthy control individuals, all were assessed by abdominal ultrasound and CT scan to determine the degree of pancreatic steatosis based on echogenicity of pancreatic tissue, and four-scale grading system as the visual assessment criteria …

Neurofilament Light Chain In Serum Of Cancer Patients With Acute Neurological Complications, Amulya Gottiparthy, Keng Lam, Suprateek Kundu, Zixi Yang, Ivo Tremont-Lukats, Sudhakar Tummala

Student and Faculty Publications

Aim: Neurofilament light chain (NfL) is a nonspecific sensitive biomarker of axonal damage.

Methods: This case series identified cancer patients with neurological complications who had serum NfL measurements and paired these results to outcomes.

Results: NfL serum levels were available in 15 patients with hematological malignancies or solid tumors. The neurological complications studied were immune effector cell-associated neurotoxicity syndrome, immune checkpoint inhibitor-related encephalopathy, anoxic brain injury, Guillain-Barre syndrome, hemophagocytic lymphohistiocytosis, transverse myelitis, paraneoplastic syndrome, central nervous system demyelinating disorder and chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. All patients but one with serum NfL >900 pg/ml died …

Implementing The Brief Confusion Assessment Method (Bcam) Delirium Screening Tool In An Emergency Department, Carolina Van Dalen

Master's Projects and Capstones

Problem: Persons with delirium have an elevated risk of falls. Thus, falls and delirium are inextricably linked. Both should be routinely screened for older adults.

Context: A 40-bed Emergency Department (ED) in the East San Francisco Bay area of Northern California and the first site among all acute care hospitals in the organization to implement the Brief Confusion Assessment Method (bCAM) delirium scoring tool within the Electronic Health Record (EHR).

Interventions: An EHR toolkit for delirium screening using bCAM was developed, tested, and implemented in the ED.

Measures: The outcome measure was the percentage of patients with a reported fall …

Reducing Healthcare-Acquired Pneumonia In A Geriatric Long-Term Care Facility, Jacob R. Magsalin

Master's Projects and Capstones

Problem: Healthcare-acquired pneumonia (HAP) is a nosocomial infection that poses a serious threat in geriatric long-term care facilities due to its high morbidity and mortality.

Context: This evidence-based quality improvement project seeks to reduce the incidence of HAP in a geriatric long-term care facility in the San Francisco Bay Area by utilizing findings

from existing literature.

Interventions: Key interventions include improving and standardizing oral care techniques and promoting education on HAP prevention to allow patients and their families to be more proactive in preventing this complication.

Measures: Outcome measures include HAP diagnosis rates after implementation, any costs saved for the …

Glial Progenitor Heterogeneity And Plasticity In The Adult Spinal Cord, Haichao Wei, Jia Qian Wu

Student and Faculty Publications

No abstract provided.

Exploring Treatment Burden In People With Type 2 Diabetes Mellitus: A Thematic Analysis In China's Primary Care Settings, Kai Lin, Mi Yao, Lesley Andrew, Rouyan Li, Yilin Chen, Jacques Oosthuizen, Moira Sim, Yongsong Chen

Research outputs 2022 to 2026

Background: Understanding treatment burden is a critical element to the effective management of Type 2 Diabetes Mellitus (T2DM). The current study aims to address the knowledge gap surrounding treatment burden of T2DM from the patient’s perspective in China’s primary care settings. Methods: A narrative review informed the creation of an a priori coding structure to identify aspects of T2DM treatment burden. Focus groups were conducted, employing a maximum variation sampling strategy to select participants from diverse sociodemographic backgrounds across urban, suburban, rural, and remote areas in China. Participants included adults with T2DM care in primary care settings for over a …

It’S About Time: Mitigating Cancer-Related Cognitive Impairments Through Findings From Computational Models Of The Wisconsin Card Sorting Task, Darren Haywood, Frank D. Baughman, Evan Dauer, Jennifer Haywood, Susan Rossell, Nicolas H. Hart

Research outputs 2022 to 2026

Background: Many cancer survivors experience cancer-related cognitive impairment (CRCI), often with significant negative consequences across various life domains. Emerging evidence suggests that allowing additional time to process information before acting may be a useful strategy for those with CRCI to mitigate some of its impacts. The Wisconsin Card Sorting Task (WCST), a measure of general cognition, has shown that for some cancer survivors, longer task completion time facilitates similar task performance outcomes to control populations concerning perseveration errors; a key performance metric of the WCST. However, assessing if this strategy may be useful, as well as determining for whom it …

Measurement Of Cumulative High-Sensitivity C-Reactive Protein And Monocyte To High-Density Lipoprotein Ratio In The Risk Prediction Of Type 2 Diabetes: A Prospective Cohort Study, Dan Wu, Genyuan Chen, Yulong Lan, Shuohua Chen, Xiong Ding, Chiju Wei, Lois Balmer, Wei Wang, Shouling Wu, Wencan Xu

Research outputs 2022 to 2026

Background: Converging data have suggested that monocytic inflammation and C-reactive protein (CRP) are biologically intertwined processes and are involved in diabetogenesis. This study aimed to investigate the association between systemic inflammation assessed by joint cumulative high-sensitivity C-reactive protein (CumCRP) and monocyte to high-density lipoprotein ratio (CumMHR) and incident type 2 diabetes (T2D) and their predictive value for T2D in a general population. Methods: A total of 40,813 nondiabetic participants from a prospective real-life cohort (Kailuan Study, China) were followed biennially from 2010/2011 until December 31, 2020. Multivariable Cox regression analyses were conducted to evaluate the adjusted hazard ratios (aHRs) of …

Joint Association Of Tyg Index And High Sensitivity C-Reactive Protein With Cardiovascular Disease: A National Cohort Study, Cancan Cui, Lin Liu, Yitian Qi, Ning Han, Haikun Xu, Zhijia Wang, Xinyun Shang, Tianjiao Han, Yining Zha, Xin Wei, Zhiyuan Wu

Research outputs 2022 to 2026

Background: Both the triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, and systemic inflammation are predictors of cardiovascular diseases; however, little is known about the coexposures and relative contributions of TyG index and inflammation to cardiovascular diseases. Using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), we conducted longitudinal analyses to evaluate the joint and mutual associations of the TyG index and high-sensitivity C-reactive protein (hsCRP) with cardiovascular events in middle-aged and older Chinese population. Methods: This study comprised 8 658 participants aged at least 45 years from the CHARLS 2011 who are …

Patient Experiences: A Qualitative Systematic Review Of Chemotherapy Adherence, Amineh Rashidi, Susma Thapa, Wasana Sandamali Kahawaththa Palliya Guruge, Shubhpreet Kaur

Research outputs 2022 to 2026

Adherence to chemotherapy treatment is recognized as a crucial health concern, especially in managing cancer patients. Chemotherapy presents challenges for patients, as it can lead to potential side effects that may adversely affect their mobility and overall function. Patients may sometimes neglect to communicate these side effects to health professionals, which can impact treatment management and leave their unresolved needs unaddressed. However, there is limited understanding of how patients’ experiences contribute to improving adherence to chemotherapy treatment and the provision of appropriate support. Therefore, gaining insights into patients’ experiences is crucial for enhancing the accompaniment and support provided during chemotherapy. …

Enhancing Circulatory Myokines And Extracellular Vesicle Uptake With Targeted Exercise In Patients With Prostate Cancer (The Myex Trial): A Single-Group Crossover Study, Jin Soo Kim, Dennis R. Taaffe, Daniel A. Galvão, Timothy D. Clay, Andrew D. Redfern, Elin S. Gray, Robert U. Newton

Research outputs 2022 to 2026

Introduction: Physical activity is associated with improved disease progression and cancer-specific survival in patients with prostate cancer (PCa). However, the mechanisms underlying these associations remain unclear, while the relative impact of exercise modes is unknown. This study aims to examine the differential impact of exercise mode on tumour-suppressive skeletal muscle-associated systemic molecules as well as their delivery mechanism. This study will compare the effects of the two main exercise modes, aerobic and resistance, on (1) circulatory myokine levels, (2) skeletal muscle-induced extracellular vesicle abundance and cargo contents, and (3) uptake of extracellular vesicles (EVs) in PCa cells in patients with …

Targeting The Glutamine-Arginine-Proline Metabolism Axis In Cancer, Di Wang, Jiang-Jie Duan, Yu-Feng Guo, Jun-Jie Chen, Tian-Qing Chen, Jun Wang, Shi-Cang Yu

Student and Faculty Publications

Metabolic abnormalities are an important feature of tumours. The glutamine-arginine-proline axis is an important node of cancer metabolism and plays a major role in amino acid metabolism. This axis also acts as a scaffold for the synthesis of other nonessential amino acids and essential metabolites. In this paper, we briefly review (1) the glutamine addiction exhibited by tumour cells with accelerated glutamine transport and metabolism; (2) the methods regulating extracellular glutamine entry, intracellular glutamine synthesis and the fate of intracellular glutamine; (3) the glutamine, proline and arginine metabolic pathways and their interaction; and (4) the research progress in tumour therapy …

Bacillus Licheniformis Suppresses Clostridium Perfringens Infection Via Modulating Inflammatory Response, Antioxidant Status, Inflammasome Activation And Microbial Homeostasis In Broilers, Xiao Xiao, Songke Qin, Tiantian Cui, Jinsong Liu, Yanping Wu, Yifan Zhong, Caimei Yang

Student and Faculty Publications

Pathogenic bacteria infection, especially Clostridium perfringens (C. perfringens), markedly threatened the health of animals, and further caused huge economic loss. In this study, Bacillus licheniformis HJ0135 (BL) was used. Oxford cup bacteriostatic test and inhibitory rate test were conducted to evaluate the antibacterial ability of BL. Results showed the strongest inhibitory role of BL on C. perfringens (P < 0.05). Afterwards, 540 one-day-old yellow-feather broilers (32.7 ± 0.2 g) were randomly allocated into 3 groups, including CON group (basal diet), CP group (basal diet + 1 × 109 CFU C. perfringens in gavage), and BL + CP group (basal diet containing 7.5 × 106 CFU/g BL + 1 × 109 CFU C. perfringens in gavage). At d 70, broilers in the CP and BL + CP groups were treated with C. perfringens by continuously oral administration for 5 d. The experiment lasted for 75 d. The serum, immune organs, jejunal mucosa, and cecal contents were collected for analysis. In vivo experiment showed that BL supplementation markedly improved (P < 0.05) BW, ADG, thymus index, serum immunoglobins and antioxidases, reduced feed conversion ratio (FCR) and serum pro-inflammatory cytokines of C. perfringens-infected broilers. Furthermore, the increased jejunal injury and levels of pro-inflammatory cytokines, decreased gene expressions of tight junction proteins in the jejunal mucosa were significantly alleviated (P < 0.05) by BL. More importantly, the activation of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome was inhibited (P < 0.05) by BL to further attenuate jejunal damage. Besides, BL supplementation markedly increased (P < 0.05) the cecal isobutyric acid and isovaleric acid. Microbial analysis showed that BL changed the composition and relative abundances of microbiota in the cecal contents (P < 0.05), especially the short chain fatty acids (SCFAs)-producing bacteria including Eubacterium_coprostanoligenes_group, Megamonas, Faecalibacterium, and Lactobacillus, which further protected against C. perfringens-induced jejunal inflammation in broilers. Our study laid a theoretical basis for the application of probiotics in lessening C. perfringens-related diseases in poultry farming.

Current Landscape Of Melanoma Clinical Trials Involving Artificial Intelligence, Raghuram Reddy, Karla Santoyo

AMNET Conferencia Internacional

This study examines the current landscape of melanoma clinical trials using artificial intelligence in the ClinicalTrials.gov database.

Interprofessional Readiness Of Athletic Trainers And Collaborating Sports Medicine Health Professionals, Michael J. Nolan, Jason S. Jordan, Kelly L. Potteiger, Anthony P. Breitbach

Internet Journal of Allied Health Sciences and Practice

Background: Interprofessional collaboration (IPC) is pivotal in modern healthcare, emphasizing collaboration among diverse health professionals for comprehensive patient care. While IPC has been extensively studied, a notable gap exists in understanding the readiness of athletic trainers (ATs) for IPC within hospital system settings. Purpose: This study seeks to address this gap by comparing the IPC readiness of ATs to colleagues from the same setting. Methods: The University of The West of England Interprofessional Questionnaire (UWE-IP) was administered to ATs and colleagues in hospital systems. This validated questionnaire measures aspects of IPC readiness across four constructs: 1.) communication and teamwork, 2.) …

The Endocannabinoid System Signaling, A Precursor To Homeostasis: A Scoping Review, Madison Sikyta, Jeff G. Konin, Matthew Kutz

Internet Journal of Allied Health Sciences and Practice

The Endocannabinoid System is a physiological system in the body that includes several receptors and ligands. Due to its relatively recent discovery, there is a need for healthcare professionals to be formally educated on the function of this system in the body. The endocannabinoid system is seen as having an increased research interest since the early 1990s given its current status of uncertainty amongst many. The goal of this scoping review is to provide a synoptic analysis of how the Endocannabinoid System functions and integrates within and between different systematic relationships in the body.

Utility Of Intraoperative Tomography In Oncological Neurosurgery: A Literature Review, José De Jesús Martínez-Manrique, Gerardo Yoshiaki Guinto-Nishimura, Juan Luis Gomez-Amador, Miguel Ángel Celis-López

LATIN Neurosurgery Journal

Objective: To discuss the available evidence regarding the use of intraoperative tomography in neurosurgical oncology and to support its use in glioma surgery.

Methods: We performed a narrative review of the available literature in the use of intraoperative tomography in neurosurgical oncology, providing illustrative cases and an expert opinion based on the authors’ experience in the treatment of this clinical entity in a high-volume center.

Results: We provide a thorough discussion regarding intraoperative tomography’s history, its workflow in the operating room, and its current applications in neurosurgical oncology, including neuronavigation registration, a guide to tumor resection, and post-resection control image. …

Experience In The Diagnosis And Treatment Of Central Nervous System Tumors In Children Under 2 Years At Baca Ortiz Pediatric Hospital - Quito, Ecuador, 2016-2019, Carlos Gabriel Flores-Enderica, Alicia Fernanda Torres-Merino, José Rodolfo Bernal-C, Jesús Enrique Castro-V

LATIN Neurosurgery Journal

Context: Central nervous system tumors in children between 0 and 2 years of age are rare, so their diagnosis and treatment constitute an important challenge for any pediatric neurosurgical center, added, the comorbidities of this age, which condition the responsibility of improving therapeutics to obtain better survival.

Objective: to describe the diagnostic and therapeutic experience of a national reference neurosurgical service, in relation to central nervous system neoplasms in children under two years of age, in addition to establishing comorbidity and prognosis.

Materials and Methods: Cross-sectional, retrospective and descriptive study that includes all patients under 2 years of age who …

Subependymomas: Clinical, Radiological Characteristics, And Surgical Outcomes, Javier Toledo, Juan M. Gil, José Nallino

LATIN Neurosurgery Journal

Introduction: Since their first description in 1945 by Sheinker, subependymomas have been reported in various series, but none with large numbers of patients. In this article, we present a series of nine cases of subependymomas treated at our institution. We examine the presentation, radiological and histological findings, treatments, and long-term follow-up in each case.

Methods: We retrospectively analyzed nine cases of subependymomas operated on at our institution between 1998 and 2019. Variables of interest included age, sex, initial manifestation, tumor size, location, extent of resection, short-term clinical evolution, and survival. Tumor size was calculated using the maximum diameter on MRI. …

Parasagittal Meningiomas: Recurrence Rate Associated With The Degree Of Tumor Resection. Review Of 26 Cases Undergoing Surgical Treatment, Rafael Contage-Winter, Eduardo Brescancin-Vieira, Apio Claudio Martins-Antunes

LATIN Neurosurgery Journal

Objective: In 1957, Simpson published an article describing the risk factors for tumor recurrence after surgical treatment. The fact that the treatment of parasagittal meningiomas is accompanied by a relatively high risk of morbidity and mortality led the authors to review the literature through their surgical series regarding the association between the degree of resection, according to the Simpson scale, and its implication on disease-free survival in parasagittal meningiomas.

Methods: Based on the analysis of their surgical series, the authors reviewed the literature focusing on the extent of surgical treatment and its relation to tumor recurrence/progression.

Results: Recurrences occurred in …

Tumors Of The Pineal Gland Region, Sergio H. Susuki, Marcio S. Rassi, Jean G. De Oliveira

LATIN Neurosurgery Journal

Pineal gland tumors are a heterogeneous and rare group of neoplasms in adults and children, categorized more by their location than by histological similarities. Their clinical presentation is variable, but due to their anatomical location and function, they frequently present with obstructive hydrocephalus, Parinaud’s syndrome, or neuroendocrine disorders. Surgical resection plays a central role in the treatment of these lesions, complemented by chemotherapy and radiotherapy in some types of tumors, making their histopathological classification fundamental.

Classification Of Primary Tumors Of The Central Nervous System: A Historical Remembrance, Carlos E. Velásquez, Diego Méndez-Rosito

LATIN Neurosurgery Journal

Tumors of the central nervous system constitute a heterogeneous group of neoplasms that range from well-differentiated and relatively benign lesions to highly invasive and poorly differentiated lesions. In the pursuit of unifying criteria to establish therapeutic options and clarify prognosis, classification systems for this group of neoplasms have emerged, which initially relied on their macroscopic characteristics and more recently have incorporated genetic studies. This constantly evolving classification brings greater accuracy in the diagnosis of neoplasms but poses new challenges for its implementation and gives rise to new questions, new study techniques, and new classification methods, understanding that what is modern …

Stereotactic-Guided Biopsy With Intraoperative Histopathological Assistance As A Strategy For Efficient Diagnosis Of Brain Lesions, Jose Luis Navarro-Olvera, Juan Camilo Covaleda-Rodríguez, Arturo Muñoz-Cobos, Gustavo Aguado-Carrillo, Kléber González-Echeverría

LATIN Neurosurgery Journal

Introduction: Stereotactic brain biopsy has become a useful surgical tool in the diagnosis and classification of brain lesions that, due to their characteristics, are not suitable for complete surgical resection. It has been proposed that its diagnostic performance increases when intraoperative cytological evaluation is performed.

Materials and Methods: Retrospective analysis of 160 consecutive patients undergoing stereotactic brain biopsy with intraoperative evaluation by neuropathology to ensure sample sufficiency and positivity for diagnosis.

Results: Histological diagnosis was achieved in 153 of the 160 cases (diagnostic yield of 95.6%). 80.63% of the lesions corresponded to neoplastic lineage, of which 53% were high-grade gliomas. …

Incidental Meningiomas: Should They Be Monitored Or Operated On?, Federico Salle, Andrea Jaume, Andrea Devita, Edgardo Spagnuolo

LATIN Neurosurgery Journal

With the increasing of medical control and the availability of brain diagnostic imaging modalities, the diagnostic of incidental meningiomas become fairly common.

A lot of studies have been published in the last years in an effort to know the potential for growth of this tumors. An important number of publications appear with suggestions of therapeutic strategies. In one hand the possibility of control of these patients and in the other hand the possibility of surgery. There are a lot of factors in each case to decide what to do. The risk of surgical complications, the age of the patient, the …

Resection Of Tumors In Eloquent Areas, Jose E. Valerio-Pascua, Noe Santiago Rea

LATIN Neurosurgery Journal

Objective: The objective of this manuscript is to show the risk-benefit of glioma resection and the loss of function depending on the affected area.

Materials and Methods: A bibliographic search was conducted in the PubMed database, filtering articles using dependent and independent variables.

Results: Navigation techniques, brain mapping, and the management of awake patients allow the resection of tumors in areas that are difficult to access surgically and have neurological function. In our experience, intra-axial tumors tend to displace tracts rather than involve them, so the ability to analyze preoperatively allows us to define safer surgical strategies for lesion resection.

Biological Nucleoplasty: Molecular Bases And Technique, Tito A. Perilla-Cepeda, Carlos Uribe-Velez, Juan Pablo Perilla-Estrada

LATIN Neurosurgery Journal

Introduction: Degenerative disc disease (DDD) is an important cause of cervical and low back pain, it represents a significant burden and cost for the health system. Conventional treatment for low back pain is divided in conservative and surgical management, however, the current trend is to perform minimally invasive (MI) procedures. Biological nucleoplasty (BN) is a MI procedure based in tissue regeneration through the use of platelet growth factors (PGF), constituting a novel, safe and cost-effective method for the treatment of DDD.

Materials and methods: This technical note reviews the molecular bases that support the use of platelet growth factors. We …

Editorial, Andres M. Rubiano

LATIN Neurosurgery Journal

No abstract provided.