Medical Specialties Commons^™

The Characterization And Evaluation Of The Soluble Triggering Receptor Expressed On Myeloid Cells-Like Transcript-1 In Stable Coronary Artery Disease, Zaida Bayrón-Marrero, Siobhan Branfield, Javier Menéndez-Pérez, Benjamín Nieves-López, Laura Ospina, Yadira Cantres-Rosario, Loyda M Melendez, Robert Hunter, Angelia Gibson, Gerónimo Maldonado-Martínez, A Valance Washington

Faculty, Staff and Student Publications

Platelets play crucial roles in the development and progression of coronary artery disease (CAD). The triggering receptor expressed in myeloid cells-like transcript-1 (TLT-1) is stored in platelet α granules, and activated platelets release a soluble fragment (sTLT-1). We set out to better characterize the constituent amino acids of sTLT-1 and to evaluate sTLT-1 for use as a biomarker in patients with stable CAD. We evaluated sTLT-1 release using immunoprecipitation and mass spectrometry and employed statistical methods to retrospectively correlate sTLT-1 concentrations, utilizing ELISA in plasma samples from 1510 patients with documented stable CAD. We identified TLT-1 residues to 133 in …

Surgical Management Of Congenital Malrotation Presenting In Adulthood., Jacob Holzemer, Krishna Patel, Oscar Ruiz, Jodi Oostra

Surgery Articles

Intestinal malrotation is characterised by positional and congenital fixation abnormalities resulting from a failure in embryonic development in the normal 270° rotation around the axis of the superior mesenteric artery. Intestinal malrotation is primarily thought to affect neonates with an incidence of 1 in 500, however, only 1 in 6000 live births are symptomatic, and these usually present within the first month of life in 40% of cases and within the first year in over 5% of cases as an obstructive pathology or volvulus. In adults, however, the incidence has been documented at 0.2%. These patients usually present with postprandial …

Autoantibodies Neutralizing Type I Ifns Underlie West Nile Virus Encephalitis In ∼40% Of Patients, Adrian Gervais, Francesca Rovida, Maria Antonietta Avanzini, Stefania Croce, Astrid Marchal, Shih-Ching Lin, Alessandro Ferrari, Christian W Thorball, Orianne Constant, Tom Le Voyer, Quentin Philippot, Jérémie Rosain, Micol Angelini, Malena Pérez Lorenzo, Lucy Bizien, Cristian Achille, Francesca Trespidi, Elisa Burdino, Irene Cassaniti, Daniele Lilleri, Chiara Fornara, José Camilla Sammartino, Danilo Cereda, Chiara Marrocu, Antonio Piralla, Chiara Valsecchi, Stefano Ricagno, Paola Cogo, Olaf Neth, Inés Marín-Cruz, Monia Pacenti, Alessandro Sinigaglia, Marta Trevisan, Andrea Volpe, Antonio Marzollo, Francesca Conti, Tiziana Lazzarotto, Andrea Pession, Pierluigi Viale, Jacques Fellay, Stefano Ghirardello, Mélodie Aubart, Valeria Ghisetti, Alessandro Aiuti, Emmanuelle Jouanguy, Paul Bastard, Elena Percivalle, Fausto Baldanti, Anne Puel, Margaret R Macdonald, Charles M Rice, Giada Rossini, Kristy O Murray, Yannick Simonin, Anna Nagy, Luisa Barzon, Laurent Abel, Michael S Diamond, Aurélie Cobat, Shen-Ying Zhang, Jean-Laurent Casanova, Alessandro Borghesi

Faculty, Staff and Students Publications

Mosquito-borne West Nile virus (WNV) infection is benign in most individuals but can cause encephalitis in <1% of infected individuals. We show that ∼35% of patients hospitalized for WNV disease (WNVD) in six independent cohorts from the EU and USA carry auto-Abs neutralizing IFN-α and/or -ω. The prevalence of these antibodies is highest in patients with encephalitis (∼40%), and that in individuals with silent WNV infection is as low as that in the general population. The odds ratios for WNVD in individuals with these auto-Abs relative to those without them in the general population range from 19.0 (95% CI 15.0–24.0, P value <10–15) for auto-Abs neutralizing only 100 pg/ml IFN-α and/or IFN-ω to 127.4 (CI 87.1–186.4, P value <10–15) for auto-Abs neutralizing both IFN-α and IFN-ω at a concentration of 10 ng/ml. These antibodies block the protective effect of IFN-α in Vero cells infected with WNV in vitro. Auto-Abs neutralizing IFN-α and/or IFN-ω underlie ∼40% of cases of WNV encephalitis.

The Impact Of Covid-19 On Carotid-Femoral Pulse Wave Velocity: A Systematic Review And Meta-Analysis, Iwona Jannasz, Michal Pruc, Mansur Rahnama-Hezavah, Tomasz Targowski, Robert Olszewski, Stepan Feduniw, Karolina Petryka, Lukasz Szarpak

Faculty, Staff and Students Publications

COVID-19 is a complex multisystemic disease that can result in long-term complications and, in severe cases, death. This study investigated the effect of COVID-19 on carotid–femoral pulse wave velocity (cfPWV) as a measurement to evaluate its impact on arterial stiffness and might help predict COVID-19-related cardiovascular (CV) complications. PubMed, Web of Science, Embase, and the Cochrane Library were searched for relevant studies, and meta-analysis was performed. The study protocol was registered in PROSPERO (nr. CRD42023434326). The Newcastle–Ottawa Quality Scale was used to evaluate the quality of the included studies. Nine studies reported cfPWV among COVID-19 patients and control groups. The …

Objectivity, Practicality, And Significance Of Practice Guidelines For The Practicing Neurologists: What We Learnt From Consensus Criteria In Cidp, Myasthenia Gravis And Inflammatory Myopathies, Marinos C. Dalakas

Department of Neurology Faculty Papers

The value of practice guidelines in the three most common autoimmune neuromuscular disorders, namely Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Myasthenia Gravis (MG) and Autoimmune Inflammatory Myopathies (AIM), has been extensively debated regarding their usefulness in clinical practice, objectivity and universal value considering that guidelines are also established regionally in certain countries. This commentary highlights common concerns on how guidelines are presently generated, pointing out: (a) non-sufficient diversity among Task-Force members to identify and address not only routine clinical and electrophysiology issues but also immunology, imaging, pathology, biomarkers, epidemiology or treatment economics; (b) Task-Force being often comprised by the same or …

Biliary Dyskinesia In Stiff Person Syndrome: An Association Between Reduced Gaba Production And Gastroenteric Dysmotility, Scarlet Louis-Jean, Nirav Agrawal, Shire Chaudhry, Adrien Mazer

Journal of Community Hospital Internal Medicine Perspectives

Stiff person syndrome (SPS) and biliary dyskinesia are two rare but potentially debilitating conditions that can significantly impact quality of life. SPS is a rare neurological disorder characterized by muscle stiffness, rigidity, and muscle spasms that primarily affect the trunk and limbs and is associated with extra-axial manifestations involving the gastrointestinal tract. Biliary dyskinesia is a gastrointestinal disorder characterized by abnormal gallbladder emptying, leading to symptoms of intense abdominal pain, nausea, and vomiting. Despite their distinct clinical presentations, studies have suggested a possible connection between the two disorders. This link may be due to involvement of similar neurotransmitters and autoantibodies …

Rhino-Cerebral Aspergillosis In An Immunocompetent Patient, Jisun Won, Carolina Severiche Mena, Joseph Glowacki, Dimple Patel

Journal of Community Hospital Internal Medicine Perspectives

Rhino-cerebral aspergillosis is a rare phenomenon describing a contiguous spread of Aspergillus species from the paranasal sinuses to the intracranial space. In this case report, we describe a case of invasive rhino-cerebral aspergillosis arising in the setting of prolonged intranasal steroid use in an 81-year-old patient with chronic sinusitis. This case report emphasizes the importance of recognizing steroid use as a risk factor for invasive aspergillosis in otherwise immunocompetent individuals.

Prevalence Of Depression In Patients With Hematologic Diseases In Marrakesh, Morocco: A Single Center Experience, Fatima Zahra Lahlimi, Oumaima Maghnouj, Khawla Khalil, Safaa Chaabane, Illias Tazi

Journal of Community Hospital Internal Medicine Perspectives

Depression in patients with cancer influences negatively their physical symptoms, treatment success, coping, and their quality of life, and it is associated with increased mortality. Reported prevalence of emotional distress in patients followed in hematology varies widely across studies. The present study aimed to investigate the prevalence of depression, and to explore the possible associated factors in patients followed in a hematological department Method: in this descriptive cross-sectional study among patients admitted to the hematology department in the University Hospital Mohammed VI of Marrakech, between August 2020 and December 2020, depression symptoms were assessed using Mini International Neuropsychiatric Interview test …

International Consensus Statement On Allergy And Rhinology: Sinonasal Tumors, Edward C. Kuan, Eric W. Wang, Nithin D. Adappa, Daniel M. Beswick, Nyall R. London, Shirley Y. Su, Marilene B. Wang, Waleed M. Abuzeid, Borislav Alexiev, Jeremiah A. Alt, Paolo Antognoni, Michelle Alonso-Basanta, Pete S. Batra, Mihir Bhayani, Diana Bell, Manuel Bernal-Sprekelsen, Christian S. Betz, Jean Yves Blay, Benjamin S. Bleier, Juliana Bonilla-Velez, Claudio Callejas, Ricardo L. Carrau, Roy R. Casiano, Paolo Castelnuovo, Rakesh K. Chandra, Vasileios Chatzinakis, Simon B. Chen, Alexander G. Chiu, Stephen C. Hernandez, Et Al

School of Medicine Faculty Publications

Background; Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology; Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. Methods; In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the …

Aenmd: Annotating Escape From Nonsense-Mediated Decay For Transcripts With Protein-Truncating Variants, Jonathan Klonowski, Qianqian Liang, Zeynep Coban-Akdemir, Cecilia Lo, Dennis Kostka

Faculty, Staff and Student Publications

DNA changes that cause premature termination codons (PTCs) represent a large fraction of clinically relevant pathogenic genomic variation. Typically, PTCs induce transcript degradation by nonsense-mediated mRNA decay (NMD) and render such changes loss-of-function alleles. However, certain PTC-containing transcripts escape NMD and can exert dominant-negative or gain-of-function (DN/GOF) effects. Therefore, systematic identification of human PTC-causing variants and their susceptibility to NMD contributes to the investigation of the role of DN/GOF alleles in human disease. Here we present aenmd, a software for annotating PTC-containing transcript-variant pairs for predicted escape from NMD. aenmd is user-friendly and self-contained. It offers functionality not currently available …

Taz2 Truncation Confers Overactivation Of P300 And Cellular Vulnerability To Hdac Inhibition, Longxia Xu, Hongwen Xuan, Wei He, Liang Zhang, Mengying Huang, Kuai Li, Hong Wen, Han Xu, Xiaobing Shi

Faculty, Staff and Student Publications

The histone acetyltransferase p300/CBP is composed of several conserved domains, among which, the TAZ2 domain is known as a protein-protein interaction domain that binds to E1A and various transcription factors. Here we show that TAZ2 has a HAT autoinhibitory function. Truncating p300/CBP at TAZ2 leads to hyperactive HAT and elevated histone H3K27 and H3K18 acetylation in cells. Mechanistically, TAZ2 cooperates with other HAT neighboring domains to maintain the HAT active site in a 'closed' state. Truncating TAZ2 or binding of transcription factors to TAZ2 induces a conformational change that 'opens' the active site for substrate acetylation. Importantly, genetic mutations that …

Endoscopic Ultrasound-Guided Transluminal Gallbladder Drainage In Patients With Acute Cholecystitis: A Prospective Multicenter Trial., Shayan S Irani, Neil R. Sharma Md, Andrew C Storm, Raj J Shah, Prabhleen Chahal, Field F Willingham, Lee Swanstrom, Todd H Baron, Eran Shlomovitz, Richard A Kozarek, Joyce A Peetermans, Edmund Mcmullen, Evelyne Ho, Schalk W Van Der Merwe

Other Specialties

OBJECTIVE: To evaluate the safety and efficacy of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS).

BACKGROUND: For patients with acute cholecystitis who are poor surgical candidates, EUS-GBD using a LAMS is an important treatment alternative to percutaneous gallbladder drainage.

METHODS: We conducted a regulatory-compliant, prospective multicenter trial at 7 tertiary referral centers in the United States of America and Belgium. Thirty consecutive patients with mild or moderate acute cholecystitis who were not candidates for cholecystectomy were enrolled between September 2019 and August 2021. Eligible patients had a LAMS placed transmurally with 30 to 60-day indwell if …

September 2023: Region 10 Emerging Special Pathogen Treatment Center (Resptc) At Providence Sacred Heart Medical Center & Children’S Hospital, Providence - Special Pathogens Program

Special Pathogens Newsletters

REGION 10 SPECIAL PATHOGENS NEWSLETTER

Case Study: The Elusive Vaginal Leiomyoma, Fiona Hodges, Roziya Tursunova, Kelly Nagy, Halei Wong, Wright State University Boonshoft Som Department Of Obstetrics And Gynecology, Wright Patterson Air Force Base Department Of Obstetrics And Gynecology

Obstetrics and Gynecology Faculty Publications

This poster was presented at the September 2023 Armed Forces District Meeting.

Diabetic Ketoacidosis Diagnosis In A Hospital Setting., Amber M Healy, Mallory Faherty, Zeryab Khan, Naveen Emara, Cody Carter, Andrew Scheidemantel, Musa Abu-Jubara, Robert Young

OhioHealth Research Institute Articles

CONTEXT: Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. Treatment algorithms include fluid resuscitation, intravenous (IV) insulin infusion, and scheduled electrolyte and glucose monitoring. The misdiagnosis of DKA in the setting of hyperglycemic emergencies results in overtreatment and unnecessary increases in healthcare utilization and costs.

OBJECTIVES: The aims of this study were to determine how often DKA is overdiagnosed in the context of other acute hyperglycemic emergencies, to describe the baseline characteristics of patients, to determine the hospital treatments for DKA, and to …

Antibiotic-Induced Gut Dysbiosis And Cognitive, Emotional, And Behavioral Changes In Rodents: A Systematic Review And Meta-Analysis, Shivdeep S. Hayer, Soonjo Hwang, Jonathan B. Clayton

Food for Health: Publications

There are previous epidemiological studies reporting associations between antibiotic use and psychiatric symptoms. Antibiotic-induced gut dysbiosis and alteration of microbiota-gut-brain axis communication has been proposed to play a role in this association. In this systematic review and meta-analysis, we reviewed published articles that have presented results on changes in cognition, emotion, and behavior in rodents (rats and mice) after antibiotic-induced gut dysbiosis. We searched three databases—PubMed, Web of Science, and SCOPUS to identify such articles using dedicated search strings and extracted data from 48 articles. Increase in anxiety and depression-like behavior was reported in 32.7 and 40.7 percent of the …

Antibiotic-Induced Gut Dysbiosis And Cognitive, Emotional, And Behavioral Changes In Rodents: A Systematic Review And Meta-Analysis, Shivdeep S. Hayer, Soonjo Hwang, Jonathan B. Clayton

Food for Health: Publications

There are previous epidemiological studies reporting associations between antibiotic use and psychiatric symptoms. Antibiotic-induced gut dysbiosis and alteration of microbiota-gut-brain axis communication has been proposed to play a role in this association. In this systematic review and meta-analysis, we reviewed published articles that have presented results on changes in cognition, emotion, and behavior in rodents (rats and mice) after antibiotic-induced gut dysbiosis. We searched three databases—PubMed, Web of Science, and SCOPUS to identify such articles using dedicated search strings and extracted data from 48 articles. Increase in anxiety and depression-like behavior was reported in 32.7 and 40.7 percent of the …

Psychiatric Comorbidity In People With Epilepsy, Bushra Khalid, Zaid Waqar, Zakir Jan, Soban Khan, Amina Saddiqa, Anum Irfan, Waleed Malik, Samer Naik, Naheed Afzal, Hira Abbasi

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective: People with epilepsy often experience psychiatric comorbidity. This study aims to investigate the relationship among seizure regulation, psychiatric comorbidity, and antiepileptic drug use in a group of individuals with epilepsy in Pakistan.

Methods: This is an observational study conducted at Pakistan Institute of Medical Sciences, over a period of six months (1st June – 31st Dec 2022). One-hundred-twenty people (sample size) with epilepsy above the age of 18 with confirmed diagnosis of epilepsy were included in the study who completed a questionnaire that assessed their seizure control, psychiatric comorbidity, and antiepileptic drug use. Data was analyzed using …

Factors Associated With Dropout From Outpatient Tertiary Mental Health Services, Nasir Mahmood, Uroosa Talib

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: There is a paucity of mental health hospital-based studies from Pakistan that have observed the contributing factors of dropout. This study aims to understand contributing factors to dropouts from mental health services.

Method: This telephonic survey was conducted as a cross-sectional study from dropout outpatients of Karwan-e-Hayat Institute for Mental Health Care, a tertiary mental care hospital in Karachi, Pakistan. Using a simple questionnaire to assess socio-demographic variables, psychosocial assessment, and patient perspectives on treatment termination. A total of 158 participants out of 200 patients provided insight into their dropout experiences.

Result: Results revealed that younger adults, …

Neuro-Palliative Medicine, Shazia Faiz

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Cyclic Alternating Pattern Of Encephalopathy (Cape) In Cns Infection: A Case Report, Zaid Waqar, Soban Khan, Maryam Khalil, Bushra Khalid, Zakir Jan, Muhammad Adil, Amina Saddiqa

Pakistan Journal of Neurological Sciences (PJNS)

Cyclic Alternating Pattern of Encephalopathy (CAPE) is rare EEG phenomenon first described in 1944 in a comatose patient. It is similar to sleep EEG pattern of cyclic alternating pattern (CAP) which is a periodic electroencephalogram activity of non-REM sleep. The cyclic alternating pattern (CAP) is defined by sequences of transient electrocortical events that are different from the tonic background and repeat at intervals of up to one minute. CAPE, however, is abnormal EEG pattern. In this pattern of EEG abnormality slow wave activity of 1-2Hz alternates with fast activity of 6-10 hertz. Here we present a case of patient with …

Anti-Caspr 2 Antibody Encephalitis: A Case Report, Maryam Khalil, Zaid Waqar, Hira Badar Abbasi, Amina Saddiqa, Bushra Khalid, Soban Khan

Pakistan Journal of Neurological Sciences (PJNS)

Encephalitis is a term denoted to Inflammation in the brain which can be due to infection, autoimmunity, or can be a part of a paraneoplastic phenomenon with malignancy. Anti-CASPR 2 antibody encephalitis is a rare form of encephalitis that can be associated with malignancy, paraneoplastic phenomenon or can be an autoimmune disease. We present a case of a young boy who presented with new onset seizures and altered sensorium and was diagnosed with anti-CASPR 2 antibody encephalitis. Anti-CASPR 2 Antibody Encephalitis is a rare form of encephalitis which due to its great diverse presentation should be kept in the differential …

Xanthine Oxidase Levels And Immune Dysregulation Are Independently Associated With Anemia In Plasmodium Falciparum Malaria, Marilyn Vasquez, Margaux Sica, Ruth Namazzi, Robert Opoka, Julian Sherman, Dibyadyuti Datta, Miquel Duran Frigola, John Ssenkusu, Chandy John, Andrea Conroy

Paediatrics and Child Health, East Africa

Severe anemia is an important contributor to mortality in children with severe malaria. Anemia in malaria is a multi-factorial complication, since dyserythropoiesis, hemolysis and phagocytic clearance of uninfected red blood cells (RBCs) can contribute to this syndrome. High levels of oxidative stress and immune dysregulation have been proposed to contribute to severe malarial anemia, facilitating the clearance of uninfected RBCs. In a cohort of 552 Ugandan children with severe malaria, we measured the levels of xanthine oxidase (XO), an oxidative enzyme that is elevated in the plasma of malaria patients. The levels of XO in children with severe anemia were …

From The Lung To The Finger: An Unusual Presentation Of Adenosquamous Cell Carcinoma, Preeti Badve, Md, Sussy Obando Lara, Md, Elisenda Valdez Pena, Md, Myriah Magaris, Do, Zunaira Naeem, Md, Charalambos Solomides, Md, Avnish Bhatia

Department of Medical Oncology Posters

Learning Objective

To recognize unusual presentations of metastatic lung disease.

Perioperative Opioids And Survival Outcomes In Resectable Head And Neck Cancer: A Systematic Review., Eric V Mastrolonardo, Derek S Mann, Harleen K. Sethi, Bo H Yun, Elliott M Sina, Maria Armache, Brooke Worster, Christopher E Fundakowski, Leila J Mady

Otolaryngology (ENT) Resident Research

BACKGROUND: Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease-free survival (DFS) in patients with resectable head and neck cancer (HNC).

METHODS: A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included.

RESULTS: Three thousand three hundred seventy-eight studies met initial inclusion …

Real-World Use Of Mold-Active Triazole Prophylaxis In The Prevention Of Invasive Fungal Diseases: Results From A Subgroup Analysis Of A Multicenter National Registry, M Hong Nguyen, Luis Ostrosky-Zeichner, Peter G Pappas, Thomas J Walsh, Joseph Bubalo, Barbara D Alexander, Marisa H Miceli, Jeanette Jiang, Yi Song, George R Thompson

Faculty, Staff and Student Publications

BACKGROUND: Antifungal prophylaxis can prevent invasive fungal diseases (IFDs) in high-risk, immunocompromised patients. This study assessed the real-world use of mold-active triazoles (MATs) for the prevention of IFDs.

METHODS: This subgroup analysis of a multicenter, observational, prospective registry in the United States from March 2017 to April 2020 included patients who received MATs for prophylaxis (isavuconazole, posaconazole, and voriconazole) at study index/enrollment. The primary objective was to describe patient characteristics and patterns of MAT use. Exploratory assessments included the frequency of breakthrough IFDs and MAT-related adverse drug reactions (ADRs).

RESULTS: A total of 1177 patients (256 isavuconazole, 397 posaconazole, 272 …

A Perspective On In Vitro Developmental Neurotoxicity Test Assay Results: An Expert Panel Review, D. R. Juberg, D. A. Fox, P. A. Forcelli, S. Kacew, J. C. Lipscomb, S. A. Saghir, Catherine M. Sherwin, C. M. Koenig, S. M. Hays, C. R. Kirman

Pediatrics Faculty Publications

For decades, there has been increasing concern about the potential developmental neurotoxicity (DNT) associated with chemicals. Regulatory agencies have historically utilized standardized in vivo testing to evaluate DNT. Owing to considerations including higher-throughput screening for DNT, reduction in animal use, and potential cost efficiencies, the development of alternative new approach methods (NAMs) occurred; specifically, the advent of the DNT in vitro test battery (DNT IVB). SciPinion convened an expert panel to address specific questions related to the interpretation of in vitro DNT test data. The consensus of the expert panel was that the DNT IVB might be used during initial …

Pulmonary & Critical Care Insider: Issue 2, Bharat Bajantri Md, Sarah Ellsworth Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 2

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:

• Spontaneous Breathing Trials
• Enteral feedings
• EFFORT Protein trial
• The NUTRIREA-3 trial
• Veno-venous extracorporeal carbon dioxide removal (vv-ECCO2 R)
• Acute hypoxemic respiratory failure (AHRF)
• Penicillin allergy
• PEN-FAST score
• Etomidate increases mortality …

Renin As A Biomarker Of Acute Kidney Injury And Mortality In Children With Severe Malaria Or Sickle Cell Disease, Daniel Adan, Anthony Batte, Ruth Namazzi, Ivan Mufumba, Caroline Kazinga, Kagan Mellencamp, Caitlin Bond, Robert Opoka, Chandy John, Andrea Conroy

Paediatrics and Child Health, East Africa

Background: Globally, a very high percentage of acute kidney injury (AKI) occurs in low- and middle-income countries (LMICs) where late recognition contributes to increased mortality. There are challenges with using existing biomarkers of AKI in LMICs. Emerging evidence suggests renin may serve as a biomarker of kidney injury that can overcome limitations in creatinine-based diagnostics.

Methods: Two study populations in Uganda were assessed. Cohort #1 was a two-site, prospective cohort study enrolling 600 children with severe malaria (SM). Cohort #2 was a prospective cohort study enrolling 185 children with sickle cell disease (SCD) hospitalized with a vaso-occlusive crisis. Plasma or …

Outpatient Management Of Urinary Tract Infections By Medical Officers In Nairobi, Kenya: Lack Of Benefit From Audit And Feedback On Adherence To Treatment Guidelines, Florence Mbatia, James Orwa, Mary B. Adam, Gulnaz Mohamoud, Rodney Adam

Family Medicine, East Africa

Introduction: Acute uncomplicated urinary tract infections are common in outpatient settings but are not treated optimally. Few studies of the outpatient use of antibiotics for specifc diagnoses have been done in sub-Saharan Africa, so little is known about the prescribing patterns of medical ofcers in the region.

Methods: Aga Khan University has 16 outpatient clinics throughout the Nairobi metro area with a medical ofcer specifcally assigned to that clinic. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records in these clinics. Then the medical ofcer from each of the 16 clinics was recruited from …