Medical Specialties Commons^™

Does Hormone Replacement Therapy Reduce Bone Resorption In Postmenopausal Women With An Intact Uterus?, Ashley Harding

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not hormone replacement therapy reduces bone resorption in postmenopausal women with an intact uterus.

STUDY DESIGN: A systematic review of three double blind randomized control trials (RCTs) published from 2016 to 2022.

DATA SOURCES: All RCTs were published in peer reviewed journals in English and were found on PubMed and Google Scholar. Articles were chosen based on relevance to the clinical question.

OUTCOME MEASURED: Level of bone resorption was measured via assessment of bone turnover markers at baseline and after use of hormone replacement therapy in all …

Perioperative Anaphylaxis In A Healthy Adolescent After First Lifetime Surgery, Shayan Sazdar, Salman Aljubran

Posters

Introduction: Perioperative anaphylaxis is a rare life-threatening event. Its evaluation poses complex considerations inherent to the use of multiple medications. Patient presentation: A healthy 11-year-old boy developed anaphylaxis shortly after discharge home from first lifetime surgery for orchiopexy. Perioperative medications included rocuronium, propofol, fentanyl, bupivacaine, sugammadex, ondansetron, dexamethasone, dexmedetomidine, and ketorolac. No antibiotics. After surgery, he consumed fast food dinner and ice cream. Within 2 hours after discharge home, he returned to our Emergency Department (ED) with facial and tongue angioedema, hives, and respiratory distress. He received multiple doses of intramuscular epinephrine and briefly required epinephrine drip in the ED. …

Asthma Phenotypes And Control In 22q11.2 Deletion Syndrome: A Single-Center Retrospective Study, Cody Shopper, Katey Campbell, Nikita S. Raje

Posters

Background: Patients with 22q11.2 deletion syndrome have increased rates of atopy and immune dysregulation and may experience a higher burden of asthma; however, real-world data describing asthma control, severity, and treatment patterns in this population are limited. We hypothesized that asthma control and severity patterns in patients with 22q11.2 deletion syndrome differ from those observed in the general asthma population. Objectives/Goal: To characterize asthma control, severity, and treatment patterns among patients with 22q11.2 deletion syndrome and to compare observed patterns with those typically reported in the general asthma population. Methods/Design: We conducted a retrospective observational cohort study of patients with …

A Case Report Of Milk-Alkali Syndrome Secondary To Excessive Antacid Use, Samir Beso, Layla Abubshait

Einstein Health Papers

INTRODUCTION: Milk-alkali syndrome is characterized by the triad of hypercalcemia, metabolic alkalosis, and acute kidney injury resulting from excessive intake of calcium and absorbable alkali. Despite falling out of prominence with the advent of modern ulcer treatments, milk-alkali syndrome has experienced a resurgence with the widespread availability of over-the-counter calcium preparations, which now account for up to 10% of hypercalcemia cases.

CASE REPORT: A 60-year-old man with multiple comorbidities presented to the emergency department with altered mental status after his scheduled kyphoplasty was canceled due to concerning neurological findings. Laboratory evaluation revealed severe hypercalcemia, marked metabolic alkalosis, and acute kidney …

Pericardial Effusion, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Total Hip Replacement Eras, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

The Scope And Impact Of Walking The Talk For Dementia 2024, Sherril B. Gelmon, Kate Irving, Walter Dawson, Jonathan Adrián Zegarra-Valdivia, Lingani Mbakile-Mahlanza, Fernando Aguzzoli-Peres

Institute on Aging Publications

Walking the Talk for Dementia (WTD) is a global educational initiative integrating a walk along the Camino de Santiago with a symposium to combat dementia stigma, raise awareness, and foster inclusion.

The 2025 Accra Declaration On Upskilling And Cost-Effective Cardiac Surgery In Africa, Charles Yankah, Jonathan Nwiloh, Carlos Mestres, Abdelmalek Bouzid, Tom Mwambu, Andrew Duncan, Mohamed Debieche, Samuel Omokhodion, Uvie Onakpoya, Matthias Angres

General Surgery, East Africa

The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from across Africa, China, Europe, South America and the USA to address the growing burden of cardiovascular disease, to share their vision for the fight against cardiovascular disease, to raise standards in the diagnosis, treatment, and recovery of patients thereby improving procedural safety and clinical outcomes in Africa. The experts agreed on the need for cost effectiveness in cardiac surgery, simulation skills training, an African regional cardiothoracic surgery database, African heart …

The Global Cancer Crisis: A Review Of Growing Burden, Deepening Inequality And Initiatives For Prevention And Early Detection, Charles Yankah, Jonathan Nwiloh, Carlos Mestres, Abdelmalek Bouzid, Tom Mwambu, Andrew Duncan, Mohamed Debieche, Samuel Omokhodion, Uvie Onakpoya, Matthias Angres

General Surgery, East Africa

Cancer constitutes one of the most urgent global health crises, with over 20 million new cases diagnosed annually worldwide, claiming 10 million lives. This devastating burden disproportionately affects vulnerable populations: 75% of cancer deaths occur in low- and middle-income countries despite these regions having lower reported incidence rates. Lung cancer leads the global toll, representing 12% of all cases but 19% of deaths, followed by breast cancer (12% of cases) and colorectal cancer (9.6%). A stark geographical inequity defines the cancer landscape—while wealthy regions such as North America, Northern Europe and Australia report the highest incidence rates, Africa and Latin …

Utilization Of Evidence-Based Secondary Preventive Therapies Post-Acute Coronary Syndrome: A Heart Registry Cohort Study In Kenya, Anthony Ochola, Jasmit Shah, Jeilan Mohamed, Harun Otieno, Anders Barasa, Felix Barasa, Constantine Akwanalo, Benard Gitura, Mzee Ngunga

Internal Medicine, East Africa

Introduction: cardiovascular disease is a growing concern in Africa, with coronary artery disease emerging as a leading cause of mortality. Despite strong evidence and international guidelines recommending secondary prevention therapy post-acute coronary syndrome (ACS)-including antiplatelet agents, statins, beta blockers, and angiotensin-converting enzyme (ACE) inhibitors-suboptimal use remains a concern, especially in low- and middle-income countries. This study aimed to quantify the use of guideline-recommended secondary prevention medications after ACS in Kenya using the data from the Kenya Heart Registry study.

Methods: a cohort study was conducted using data from the Kenya Heart Registry across three hospitals in Kenya from …

International Normative Charts For Twin Weight, Length, And Head Circumference At Birth, By Gestational Age And Sex: The Twin Neonatal Cross-Sectional Study Of The Intergrowth-21st Project, Francesca Giuliani, Sonia Deantoni, Enrico Bertino, Yasmin A. Jaffer, Manorama Purwar, Fernando C. Barros, Leila Cheikh Ismail, Wu Qingqing, Ilaria Stura, Maria Carvalho

Obstetrics and Gynaecology, East Africa

Assessing the size of twins at birth using charts developed for singletons may over diagnose small for gestational age in this sub-population. The study aimed to produce international, twin-specific, newborn size normative charts by gestational age and sex. This longitudinal observational study in eight geographically diverse settings prospectively collected data between May 2009 and August 2013 from healthy pregnant women and their newborn twins. The participants were enrolled as part of the INTERGROWTH-21st study, and recruited based on World Health Organization recommendations for evaluation of anthropometric measures. All the women met, in addition to the underlying population characteristics of low …

The Use Of A Standardized Checklist For Image Acquisition: An Obstetric Ultrasound Quality Improvement Study, Ingrid Gichere, Nidhi Leekha, Sikolia Wanyonyi

Obstetrics and Gynaecology, East Africa

Introduction A complete anatomical survey during the mid-trimester ultrasound is critical for detecting fetal anomalies. In sub-Saharan Africa, detection rates remain low, contributing to a significant disease burden. This study evaluated whether implementing a standardized electronic checklist, based on existing guidelines, would improve image acquisition.

Methods We carried out a pre- and post-intervention quasi-experimental quality improvement study. An electronic checklist replaced the previous ultrasound report template. A baseline review involved 385 mid-trimester scans conducted between November 2022 and December 2023. Following checklist implementation and targeted sonographer training, 238 scans were reassessed from July to December 2024. The image acquisition rate …

Can Tanzanian Neurosurgeons Access Tanzanian Neurosurgical Literature? A Systematic Review And Survey Of Neurosurgical Publications, Romani R. Sabas, Julie Woodfield, Chibuikem Anthony Ikwuegbuenyi, Magalie Cadieux, Consolata Shayo, Zarina Shabhay, Happiness Rabiel, Beverly Cheserem, Joel Bwemelo, Drew N. Wright

General Surgery, East Africa

Background and Objectives: Free and open access to research data and findings promotes equity in access to healthcare knowledge and equity in patient care and treatment. To benefit the health care of the population studied, research findings must be accessible to clinicians, academics, and policymakers serving those populations. The aim of this study was to assess the extent of published Tanzanian neurosurgical data and its accessibility to those practicing within the country.

Methods: A systematic review of all published neurosurgical studies from Tanzania was conducted. Authorship, funding, and open-access status were recorded. Tanzanian neurosurgeons were surveyed by telephone or in …

Prospective Evaluation Of The European Society Of Cardiology 0/1h-Algorithm’S Safety And Efficacy For Triage Of Patients With Suspected Myocardial Infarction (Presc1se-Mi): Rationale And Design Of A Prospective International Multicenter Stepped-Wedge Cluster Randomized Controlled Trial, Dagmar I Keller, Ksenija Slankamenac, Michael Christ, Philipp Schuetz, Andrea Wiencierz, Ivo Strebel, Julia Reinhardt, Iryna Vyshnevska, Tzu-Ying Tsao, Felix Mahfoud, Maria Pia Ruggieri, Stephan Steuer, Òscar Miró, Veli-Pekka Harjola, Fulvio Morello, Peiman Nazerian, Dominik Roth, José Luis Zamorano, Deborah Erica Gannon, Jason Pott, Mohammed Oa Abubakr, Hyun Suk Yang, Joe Young, Richina Bicette, Andreea Cuculici, Héctor Bueno, Juan Sanchis, Christian Mueller

Faculty, Staff and Students Publications

Background: International practice guidelines recommend the more rapid European Society of Cardiology (ESC) 0/1h-algorithm for the triage of patients with suspected myocardial infarction (MI) as the preferred option and consider the ESC 0/3h-algorithm as an alternative. However, many centers worldwide have not yet adopted the ESC 0/1h-algorithm in clinical practice due to uncertainty which approach best balances safety and efficacy.

Methods: PRESC1SE-MI (PRospective Evaluation of the European Society of Cardiology 0/1h-algorithm`s Safety and Efficacy for Triage of Patients with Suspected Myocardial Infarction) is an international, investigator-initiated multicenter, stepped-wedge, cluster randomized controlled trial. At least 52,156 consecutive adult patients with nontraumatic …

Feasibility And Implementation Of Interval-Gap4: A Global Randomised Controlled Trial Of Intense Hybrid-Supervised/Self-Managed Versus Self-Directed Exercise For Metastatic Prostate Cancer, Stacey A. Kenfield, Nicolas H. Hart, Kerry S. Courneya, Rosemary Greenwood, June M. Chan, Jennette Sison, Li Zhang, Sarah Rudman, Leah Ung, Moritz Schumann, Erin L. Van Blarigan, Sam Mckeown, Charles J. Ryan, James Catto, Daniel A. Galvão, Robert U. Newton, Fred Saad

Research outputs 2022 to 2026

Background and objective: Physical activity is associated with a lower risk of mortality in men with prostate cancer (PC); yet, randomised controlled trials with survival endpoints are nonexistent. INTense ExeRcise for surviVAL-Global Action Plan 4 (INTERVAL-GAP4) was a global phase 3 trial designed to test whether structured, hybrid-supervised/self-managed exercise improves survival in men with metastatic PC. The trial was stopped early due to poor accrual. This paper reports feasibility and implementation outcomes. Methods: Men with metastatic PC were randomised (1:1) to a supervised/self-managed moderate- to high-intensity resistance and aerobic programme (three sessions per week for 2 yr) or to self-directed …

Increasing Phytochemical-Rich Foods And Lactobacillus Probiotics In Men With Low-Risk Prostate Cancer – A Randomised, Double-Blind, Placebo-Controlled Trial, Robert J. Thomas, Stacey A. Kenfield, Madeleine Williams, Robert U. Newton, Jeffrey Aldous, Anita Mitra, Zahoor Fazili

Research outputs 2022 to 2026

Men on active surveillance (AS), with prostate cancer, are very interested in dietary strategies that could improve their symptoms and help prevent progression of their disease. In this real-world trial involving 208 men, intake of phytochemical-rich food capsules helped slow prostate-specific antigen (PSA) progression significantly, and improved urinary symptoms and erectile function. What was novel about this study was that men randomised to take an additional blend of five Lactobacillus probiotics had a further three-fold slowing of PSA progression as well as reduction of inflammation. Currently, nearly 50% of men opt out of AS within 5 yr. If confirmed with …

Validation Of The French Translation Of The Movement Disorder Society Non-Motor Symptoms Scale (Mds-Nms) In Parkinson's Disease, Luowen Yu, Christopher G Goetz, Glenn T Stebbins, Pablo Martinez-Martin, Monica M Kurtis, Tiago A Mestre, Alvaro Sanchez-Ferro, Michelle H S Tosin, Roberta Balestrino, Chi-Ying R Lin, Carmen Gasca-Salas, Tatiana Witjas, Olivier Colin, David Maltete, Luc Defebvre, Caroline Giordana, Mahmoud Charif, Claire Thiriez, Chloé Laurencin, Mélissa Tir, Gwendoline Dupont, Philippe Remy, Christine Tranchant, Sophie Drapier, Alexandra Samier, Isabelle Benatru, Sara Sambin, Jean-Christophe Corvol, Fatma Khelifi, Margherita Fabbri, Olivier Rascol, Ns‐Part Cohort Study Group And The Mds Coa Translation Steering Committee

Faculty, Staff and Students Publications

No abstract provided.

Minifast: A Sensitive And Fast Miniaturized Microscope For In Vivo Neural Recording, Blake Madruga, Conor C Dorian, Alexander V Rodriguez, Savva Morozov, Daniel Aharoni, Jacob T Robinson, François St-Pierre, Peyman Golshani, Caleb Kemere

Faculty, Staff and Students Publications

Significance: Observing the activity of large populations of neurons in vivo is critical for understanding brain function and dysfunction. The use of fluorescent genetically encoded calcium indicators (GECIs) in conjunction with miniaturized microscopes is an exciting emerging toolset for recording neural activity in unrestrained animals. Despite their potential, current miniaturized microscope designs are limited using image sensors with low frame rates, sensitivity, and resolution. Beyond GECIs, there are many neuroscience applications that would benefit from the use of other emerging neural indicators, such as fluorescent genetically encoded voltage indicators (GEVIs) that have faster temporal resolution to match neuron spiking, yet …

Trans-Broad-Ligament Abdominal Cerclage Versus Blind Needle-Piercing Abdominal Cerclage During Pregnancy: A Comparison Of Surgical Outcomes, Lubna Chohan, Jugnu Biba Nijjar, Nurul Farhanah Binte Abdul Latif, Zhenkun Guan, Xiaoming Guan

Faculty, Staff and Students Publications

No abstract provided.

Utilization Of Intensive Care Interventions In Critically Ill Patients With Candidemia Versus Bacteremia: A Multicenter Retrospective Cohort Study, James Kurian, Aarjav Sanghvi, Enshuo Hsu, Stephen L Jones, Ashton Connor, David B Corry, Cesar A Arias, Max W Adelman

Faculty, Staff and Students Publications

Objectives: Candida species are one of the most common causes of ICU-onset bloodstream infection (BSI). Yet, there is no robust guidance on when to initiate empiric antifungals for ICU patients suspected of BSI. We compared patients with ICU-onset candidemia vs. ICU-onset bacteremia to determine which patients may benefit from empiric antifungals.

Design: We compared characteristics between patients with bacteremia vs. candidemia at time of culture. We determined risk factors for death and constructed a multivariable regression to determine if candidemia is an independent risk factor for death.

Setting/patients: We included ICU patients from a hospital system in Houston, Texas (n …

Bradycardia, Asystole, And Sudden Cardiac Death In Zc4h2 R198q-Associated Wieacker-Wolff Syndrome, Taylor A Beecroft-Dawson, Steven B Wolfe, Taylor S Howard, Christina Y Miyake

Faculty, Staff and Students Publications

No abstract provided.

Secondary Prophylaxis Of Variceal Hemorrhage In Biliary Atresia-Analysis Of Prospective Multicenter Studies, Benjamin L Shneider, Childhood Liver Disease Research Network (Children)

Faculty, Staff and Students Publications

No abstract provided.

Identification Of Affinity-Optimized Peptide Binders Of A Viral Protease For Chemical Genetic Applications, Glenna W Foight, Douglas M Fowler, Dustin J Maly

Faculty, Staff and Students Publications

Chemically-controlled genetic tools are useful for studying biological systems due to their ability to dose-dependently and temporally modulate intracellular function. Chemically-disrupted proximity (CDP) systems, which involve the pre-localization of two interacting protein components that can be disrupted with a small molecule, are complementary to more commonly used chemically-inducible dimerization (CID) systems. However, fewer CDP systems have been developed, and the genetically-encoded protein components have not been as optimized for intracellular applications. Here, we describe a transcriptional activation reporter assay for screening the intracellular interaction between the 21-amino acid peptide ANR and HCVp NS3a, which are the genetically-encoded components of a …

Glutathione Synthesis Via The Cystine/Glutamate Transporter Promotes The Formation Of Tertiary Lymphoid Structures In The Kidney, Takahisa Yoshikawa, Yuta Matsuoka, Rae Maeda, Hiroyuki Neyama, Ryo Kamimatsuse, Shima Goto, Keisuke Taniguchi, Naoya Toriu, Makiko Kondo, Yuki Sato, Shingo Fukuma, Motoko Yanagita

Faculty, Staff and Students Publications

Key Points:

1. Glutathione accumulated in tertiary lymphoid structures (TLS), where dendritic cells and fibroblasts specifically expressed cystine/glutamate transporter.

2. Pharmacologic inhibition of the cystine/glutamate transporter prevented the formation of TLS.

3. Urinary glutathione concentrations efficiently detected the presence of TLS in the kidney in mice and humans.

Background: Tertiary lymphoid structure (TLS), an ectopic lymphoid tissue induced under chronic inflammation, develops in various kidney diseases and is associated with poor prognosis. The immune system requires metabolic resources to support immune function and lymphocyte proliferation. Hence, dramatic metabolic alterations presumably occur during the formation of TLS. However, it remains unclear whether metabolic remodeling …

Differentiating Between Bk Activation And Potentiation By Vanzacaftor Enantiomers, Matthias Salathe

Faculty, Staff and Students Publications

No abstract provided.

Radiation Realities: Radiation Safety Practices And Awareness Among Interventional Echocardiographers In The United States, Stephen Little, Omar Khalique, Renuka Jain

Faculty, Staff and Students Publications

Background: With the rise of structural heart interventions (SHIs), interventional echocardiographers (IEs) face significant radiation exposure in catheterization laboratories. However, US-specific radiation safety practices remain understudied. This study aims to address radiation safety practices and concerns among US IEs, focusing on occupational risks and sex-specific challenges.

Methods: A 21-item online survey was conducted from March to June 2025, targeting US IEs through a multifaceted recruitment strategy. It assessed demographics, SHI frequency, radiation monitoring, shielding practices, and reproductive health concerns. Descriptive statistics summarized responses, with sex-specific analyses for female IEs.

Results: Of 69 respondents (64% [n = 44] men, 36% [n …

Differential Longitudinal Effects Of Glucose-Lowering Medications On Glucagon And C-Peptide Responses In The Glycemia Reduction Approaches In Diabetes: A Comparative Effectiveness Study (Grade), Ashok Balasubramanyam, Mary Ann Banerji, Joshua Barzilay, Robert M Cohen, W Timothy Garvey, Michaela R Gramzinski, Neda Rasouli, Mary Rhee, Jesse C Seegmiller, Vatsala Singh, William I Sivitz, Michael W Steffes, Kristina Utzschneider, Ralph A Defronzo

Faculty, Staff and Students Publications

Objective: To determine the longitudinal effects on α-cell function of four classes of glucose-lowering agents added to metformin in adults with type 2 diabetes.

Research design and methods: In a multicenter, randomized study, 5,047 participants ≥30 years of age with type 2 diabetes taking 1,000-2,000 mg metformin daily, HbA1c 6.8%-8.5%, were randomized to receive insulin glargine U100, glimepiride, liraglutide, or sitagliptin. In a subset of 724 participants, baseline and longitudinal measures of α-cell function were assessed as the fasting glucagon concentration and change in glucagon from fasting to 30 min following oral glucose (glucagon index [GGI]). Whether these measures and …

Hyperglycemia, Receptor For Advanced Glycation End Products, And Small Airways Dysfunction In Asthma, Amrit Koirala, Cristian Coarfa, Meredith C Mccormack, Nicola A Hanania, Tianshi David Wu

Faculty, Staff and Students Publications

Background: Diabetes and insulin resistance are associated with higher risk of asthma exacerbation and preserved ratio impaired spirometry (PRISm), but the pathophysiology is unclear. These conditions may cause small airways dysfunction (SAD), which is an under-recognized cause of PRISm.

Objective: To determine whether insulin resistance and poor glucose control associate with SAD and to explore whether proteins prognostic of diabetes end-organ complications predict lung function abnormalities.

Methods: We recruited a prospective cohort of adults with physician-diagnosed asthma. Fasting insulin, glucose, hemoglobin A1c, and concentrations of 13 proteins prognostic of diabetes end-organ complications were measured. Static insulin resistance was calculated by …

Nasal Microbiome And Phageome Profiles Are Associated With Prospective Respiratory Viral Infection Risk In School-Age Children, Dastan Haghnazari, Aribah Baig, Ye Sun, Bryan R Lenneman, Michael J Tisza, Amparito Cunningham, Diane Gold, Wanda Phipatanakul, Peggy S Lai

Faculty, Staff and Students Publications

Background: Respiratory viral infections are common and can trigger asthma exacerbations in children. The roles of the nasal microbiome and phageome (viruses that infect microbes) are not well understood.

Objective: We sought to characterize the epidemiology of respiratory viral infections and the interplay between the nasal microbiome, phageome, and viral infections in school-age children with asthma.

Methods: We performed metagenomic sequencing and quantitative RT-PCR detection of respiratory viruses on 375 nasal samples from 227 school-age children with asthma collected routinely 3 times over a year. Surveys on parent-reported cold and asthma symptoms were administered routinely every 2 months. We evaluated …

Single Cell Transcriptomic Landscape Of Adult And Pediatric Non-Ischemic Cardiomyopathy, Joseph A Spinner, Iki Adachi, Xiao Li, James F Martin

Faculty, Staff and Students Publications

Non-ischemic cardiomyopathy (NICM) is a devastating diagnosis with a wide array of phenotypes, ranging from mild cardiac hypertrophy to end-stage heart failure. Single-cell/nucleus RNA sequencing technologies have expanded and become a necessary tool to unravel the transcriptome across thousands to millions of cells. Studies incorporating these technologies to examine pediatric and adult myocardium have improved our understanding of underlying pathophysiology in cardiomyopathy, identified novel gene and genetic pathway associations, and paved the way for precision medicine therapeutics in cardiovascular medicine. We compiled the recent literature that showcase single cell/nucleus technologies in NICM in adult and pediatric populations and describe cell …