Internal Medicine Commons^™

Safety Of Exercise For Adults With Thoracic Aortic Aneurysms And Dissections, Jesse Li, Alexandra Boyd, Michael Huang, Joshua Berookhim, Siddharth K Prakash

Faculty, Staff and Student Publications

BACKGROUND: Current guidelines for patients with thoracic aortic aneurysms or dissections (TAD) restrict vigorous exertion with the intention to prevent acute aortic dissections. However, a safe threshold for exercise intensity has not been established for TAD patients. In this study, we measured exertional changes in systolic and diastolic blood pressure during isometric and dynamic exercises in a cohort of TAD patients to determine safety of moderate intensity exercise.

METHODS: Thirty-one adults with TAD and 14 controls were recruited from UTHealth outpatient clinics. All participants completed an exercise protocol consisting of two circuits of five moderate intensity exercises: hand grips, leg …

Sr9009 Improves Heart Function After Pressure Overload Independent Of Cardiac Rev-Erb, Hui Li, Shiyang Song, Chih-Liang Tien, Lei Qi, Andrea Graves, Eleni Nasiotis, Thomas P Burris, Yuanbiao Zhao, Zheng Sun, Lilei Zhang

Faculty, Staff and Students Publications

The core clock component REV-ERB is essential for heart function. Previous studies show that REV-ERB agonist SR9009 ameliorates heart remodeling in the pressure overload model with transverse aortic constriction (TAC). However, it is unknown whether SR9009 indeed works through cardiac REV-ERB, given that SR9009 might target other proteins and that REV-ERB in non-cardiac tissues might regulate cardiac functions indirectly. To address this question, we generated the REV-ERBα/β cardiac-specific double knockout mice (cDKO). We found that REV-ERB cardiac deficiency leads to profound dilated cardiac myopathy after TAC compared to wild-type (WT) control mice, confirming the critical role of REV-ERB in protecting …

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …

Ucp3 (Uncoupling Protein 3) Insufficiency Exacerbates Left Ventricular Diastolic Dysfunction During Angiotensin Ii-Induced Hypertension, Xu Chen, Sadia Ashraf, Nadia Ashraf, Romain Harmancey

Faculty, Staff and Student Publications

Background Left ventricular diastolic dysfunction, an early stage in the pathogenesis of heart failure with preserved ejection fraction, is exacerbated by joint exposure to hypertension and obesity; however, the molecular mechanisms involved remain uncertain. The mitochondrial UCP3 (uncoupling protein 3) is downregulated in the heart with obesity. Here, we used a rat model of UCP3 haploinsufficiency (ucp3

The Relation Of Abo Blood Group To The Severity Of Coronavirus Disease: A Cross-Sectional Study From A Tertiary Care Hospital In Karachi, Fazal Ur Rehman, Syed Furrukh Omair, Fatima Memon, Bakhtawar J. Rind, Danish Ahmed Memon, Syed Ahsan Ali, Bilal Ahmed, Naureen Ali

Section of Internal Medicine

Background: Blood groups are considered to have an impact on the occurrence and severity of coronavirus disease. While among Chinese and Caucasian, blood group O individuals were less and group A were more likely to have severe disease and mortality, data on South Asians aren’t available.
Objective: This study aimed to find out the association of disease severity with blood group among coronavirus disease 2019 (COVID-19) patients.
Materials and methodology: Data were collected on a predesigned questionnaire containing details of patient demographics, medical comorbidities, clinical presentation, and laboratory parameters. Multiple logistic regression was used to determine the association of the …

Cross-Sectional Analysis Of Patient-Centered Language Use In Journals Publishing Research Focused On Heart Failure, Vivian Pham, Benjamin Greiner, Ryan Ottwell, Matt Vassar, Micah L. Hartwell

Journal of Patient-Centered Research and Reviews

Purpose: Detrimental effects of using non–patient-centered language (nPCL) have been reported for diabetes, mental illness, and obesity, and both the American Medical Association (AMA) and International Committee of Medical Journal Editors (ICMJE) recommend using patient-centered language in medical literature. Heart failure is a common yet stigmatized disease, and nPCL may further propagate stigma. This study analyzed current use of nPCL in journals focused on heart failure research and also examined whether the journals steer authors to adhere to AMA or ICMJE guidelines regarding nPCL.

Methods: Following systematic search of PubMed for heart failure-related articles published from May 1, 2018, to …

Cushing’S Reflex And Bradycardic Arrest In Cryptococcal Meningitis, Scott Briggs, Trent Malcolm

Rowan-Virtua Research Day

Cushing’s reflex is a physiologic response to maintain cerebral perfusion pressure with elevated systolic blood pressure, widened pulse pressure, and bradycardia occurring in the setting of elevated intracranial pressure (ICP). The proposed mechanisms for reflexive bradycardia include ischemia to medullary brain tissue and compression of the intracranial segment of the vagus nerve leading to parasympathetic activation. (1) In acutely elevated ICP, bradycardia is a late finding of worsening intracranial pathology suggestive of impending herniation and cardiovascular collapse.

Cryptococcal meningitis has been identified by Infectious Disease Society of America for its association with elevated ICP. (2) Variety of pathogenic mechanisms occurring …

Heart-Healthy Integrative Nutritional Counseling Group Education Sessions Among Chinese Americans With Cardiovascular Risk Factors Or Disease: A Primary Care Quality Improvement Pilot, Jasmin Woo, Evelyn Y. Ho, Jane Jih

Journal of Patient-Centered Research and Reviews

Purpose: Current biomedical cardiovascular disease nutrition counseling does not incorporate Chinese medicine principles.

Methods: A heart-healthy integrative nutritional counseling (H2INC) curriculum consistent with Chinese medicine principles and biomedical nutrition guidelines was taught to Chinese Americans in group education sessions. Chinese-speaking patients with cardiovascular disease or risk factors from an urban general medicine practice were recruited to attend a 90-minute group session. Participants completed pre-post surveys to assess the impact of H2INC on their perceived heart-healthy nutrition knowledge and empowerment, as well as the cultural relevance of H2INC.

Results: A total of 47 participants (mean age: 74 years; 63.8% female) attended …

A Phase Ii Study Of Autologous Mesenchymal Stromal Cells And C-Kit Positive Cardiac Cells, Alone Or In Combination, In Patients With Ischaemic Heart Failure: The Cctrn Concert-Hf Trial, Roberto Bolli, Raul D Mitrani, Joshua M Hare, Carl J Pepine, Emerson C Perin, James T Willerson, Jay H Traverse, Timothy D Henry, Phillip C Yang, Michael P Murphy, Keith L March, Ivonne H Schulman, Sohail Ikram, David P Lee, Connor O'Brien, Joao A Lima, Mohammad R Ostovaneh, Bharath Ambale-Venkatesh, Gregory Lewis, Aisha Khan, Ketty Bacallao, Krystalenia Valasaki, Bangon Longsomboon, Adrian P Gee, Sara Richman, Doris A Taylor, Dejian Lai, Shelly L Sayre, Judy Bettencourt, Rachel W Vojvodic, Michelle L Cohen, Lara Simpson, David Aguilar, Catalin Loghin, Lem Moyé, Ray F Ebert, Barry R Davis, Robert D Simari

Faculty, Staff and Student Publications

AIMS: CONCERT-HF is an NHLBI-sponsored, double-blind, placebo-controlled, Phase II trial designed to determine whether treatment with autologous bone marrow-derived mesenchymal stromal cells (MSCs) and c-kit positive cardiac cells (CPCs), given alone or in combination, is feasible, safe, and beneficial in patients with heart failure (HF) caused by ischaemic cardiomyopathy.

METHODS AND RESULTS: Patients were randomized (1:1:1:1) to transendocardial injection of MSCs combined with CPCs, MSCs alone, CPCs alone, or placebo, and followed for 12 months. Seven centres enrolled 125 participants with left ventricular ejection fraction of 28.6 ± 6.1% and scar size 19.4 ± 5.8%, in New York Heart Association …

Association Of Nt-Probnp, Blood Pressure, And Cardiovascular Events: The Aric Study, Aliza Hussain, Wensheng Sun, Anita Deswal, James A De Lemos, John W Mcevoy, Ron C Hoogeveen, Kunihiro Matsushita, David Aguilar, Biykem Bozkurt, Salim S Virani, Amil M Shah, Elizabeth Selvin, Chiadi Ndumule, Christie M Ballantyne, Vijay Nambi

Faculty, Staff and Students Publications

BACKGROUND: Although intensive blood pressure reduction has cardiovascular benefits, the absolute benefit is greater in those at higher cardiovascular disease (CVD) risk.

OBJECTIVES: This study examined whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) helps identify subjects at higher risk for CVD events across systolic blood pressure (SBP), diastolic blood pressure (DBP), or pulse pressure (PP) categories.

METHODS: Participants from the ARIC (Atherosclerosis Risk In Communities) study visit 4 (1996 to 98) were grouped according to SBP, DBP, or PP categories and further stratified by NT-proBNP categories. Cox regression models were used to estimate hazard ratios for incident CVD (coronary heart disease, …

Management Of Refractory Ventricular Fibrillation With Double Sequential Defibrillation, Kaitlyn A. Brown

Capstone Showcase

Patients experiencing cardiac arrest are treated according to ACLS protocols, however current protocols lack recommendations for the treatment of refractory Ventricular Fibrillation which persists after more than 3 cycles of CPR and defibrillation. One potential intervention for these cases that is being researched is the use of simultaneous or sequential activation of two defibrillators. This literature review analyzed the results of several studies to determine if double sequential defibrillation (DSD) is a viable treatment to achieve return of spontaneous circulation (ROSC) and improved patient survival. The results of the studies were mixed with some showing positive outcomes, and others showing …

Flash Pulmonary Edema: A Case And Review Of Left Ventricular Non-Compaction Cardiomyopathy, Paula J. Watts, Oliver S. Garbo, Wendy Barrett, Michael Kopstein, Ryan Maybrook, Dmitriy Scherbak

HCA Healthcare Journal of Medicine

Left ventricular non-compaction cardiomyopathy is an uncommon type of cardiomyopathy caused by malformation of the myocardium during embryogenesis. This results in trabeculations within the ventricular wall that can affect the left and, less commonly, right ventricles. Presentation ranges from clinically asymptomatic to life-threatening arrhythmias. It is a rare and relatively unknown form of cardiomyopathy, though thought to be underdiagnosed. Prevalence is increasing due to improvements in imaging and awareness. Management is similar to that of other cardiomyopathies including angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, beta-blockers, diuretics, automatic implantable cardioverter defibrillator placement and cardiac transplantation. We present a case of a …

Differences In Angiographic Profile And Immediate Outcome Of Primary Percutaneous Coronary Intervention In Otherwise Risk-Free Young Male Smokers, Salik Ahmed, Sanam Khowaja, Saher Khowaja, Tariq Ashraf, Kanwal Aamir, Mahesh K. Batra, Musa Karim, Muhammad Anis M. Ahmedani, Syed Z. Jamal

Section of Internal Medicine

Introduction: Cigarette smoking is a well-established risk factor for the development and progression of coronary artery disease (CAD) and it is strongly related to cardiac morbidity and mortality. Therefore, this study aimed to compare the angiographic profile and immediate clinical outcomes in young male smokers and non-smokers without any other cardiac risk factors presented with ST-elevation myocardial infarction (STEMI).
Methods: This study includes young (≤40 years) male patients presented without cardiac risk factors other than smoking. Angiographic profile and immediate outcome of primary percutaneous coronary intervention (PCI) were collected from the hospital database.
Results: A total of 580 young male …

Kounis Syndrome, Charles Doerner, Mark Sawh, Tamer A. Amer, Konstantinos Marmagkiolis

West Florida Division GME Research Day 2020

Kounis syndrome, also known as allergic vasospastic angina, is a type of acute coronary syndrome caused by an allergic reaction or immune response to a substance.[1] It is essentially an “allergic angina” which is believed to be caused by mast cell activation and release of cytokines and histamine causing spasm of the artery leading to acute coronary syndrome and acute myocardial infarction. Stress cardiomyopathy (Takotsubo syndrome), which predominantly affects post-menopausal women, may also occur in anaphylaxis where transient ventricular dysfunction associated with regional ventricular wall abnormalities extending beyond the regions of coronary blood supply ensues.[2] The suspected prevalence of Kounis …

Idiopathic Chylopericardium: A Rare Entity, Seema Jaga, Joseph Namey, Christiano Caldeira, Salah Al-Andary

West Florida Division GME Research Day 2020

• Idiopathic chylopericardiumis a rare entity in which the acculumation of chylousfluid surrounds the pericardial space.
• Herein, we present a case of a 50 year old healthy female patient with no known past medical history that was diagnosed with idiopathic chylopericardiumand was successfully treated using a pleurXcatheter drainage for two and a half weeks and a low fat diet.

Progressive Collateral Stenosis Leading To Symptomatic Chronic Total Occlusion, Farhan Shah, Andrew Maiolo

Capital Division GME Virtual Research Day 2020

Chronic total occlusion is defined as the complete obstruction of a coronary artery, with TIMI 0 or TIMI 1 flow, and an occlusion duration of greater than 3 months. We present a case of symptomatic chronic total occlusion in a functional 79 year old female with no past history of coronary artery disease, previously asymptomatic due to robust collateral circulation.

Dietary Fat And Sugar Differentially Affect Β-Adrenergic Stimulation Of Cardiac Erk And Akt Pathways In C57bl/6 Male Mice Subjected To High-Calorie Feeding, Sadia Ashraf, Gizem Yilmaz, Xu Chen, Romain Harmancey

Faculty, Staff and Student Publications

BACKGROUND: High dietary fat and sugar promote cardiac hypertrophy independently from an increase in blood pressure. The respective contribution that each macronutrient exerts on cardiac growth signaling pathways remains unclear.

OBJECTIVE: The goal of this study was to investigate the mechanisms by which high amounts of dietary fat and sugar affect cardiac growth regulatory pathways.

METHODS: Male C57BL/6 mice (9 wk old; n = 20/group) were fed a standard rodent diet (STD; kcal% protein-fat-carbohydrate, 29-17-54), a high-fat diet (HFD; 20-60-20), a high-fat and high-sugar Western diet (WD; 20-45-35), a high-sugar diet with mixed carbohydrates (HCD; 20-10-70), or a high-sucrose diet …

Pitfalls In Quantitative Myocardial Pet Perfusion I: Myocardial Partial Volume Correction, K Lance Gould, Linh Bui, Danai Kitkungvan, Tinsu Pan, Amanda E Roby, Tung T Nguyen, Nils P Johnson

Faculty, Staff and Student Publications

BACKGROUND: PET quantitative myocardial perfusion requires correction for partial volume loss due to one-dimensional LV wall thickness smaller than scanner resolution.

METHODS: We aimed to assess accuracy of risk stratification for death, MI, or revascularization after PET using partial volume corrections derived from two-dimensional ACR and three-dimensional NEMA phantoms for 3987 diagnostic rest-stress perfusion PETs and 187 MACE events. NEMA, ACR, and Tree phantoms were imaged with Rb-82 or F-18 for size-dependent partial volume loss. Perfusion and Coronary Flow Capacity were recalculated using different ACR- and NEMA-derived partial volume corrections compared by Kolmogorov-Smirnov statistics to standard perfusion metrics with established …

Case Series Of Anca Vasculitis As Prognostic Marker For Severity Or Relapse Of Glomerulonephritis., Jake N. Cho, Venkat Chitumalla, Izuchukwu Nwakoby

Nephrology

No abstract provided.

Phlegmasia Cerulea Dolens In May Thurner Syndrome: A Threat To Life & Limb, Matt Mcmaster, Rage Geringer Md, Gregory Hicks Md, Oliwier Dziadkowiec

Internal Medicine

No abstract provided.

Assessment Of Guideline Recommended Anti-Coagulation Rates For Atrial Fibrillation In An Outpatient Resident Clinic, Kanav Gupta Md, Emily Langnas Do, Zahra Khaled, Travis Tagami Do, Alexandra Halalau Md

Internal Medicine

No abstract provided.

Giant 75mm Intracranial Aneurysm Masquerading As Primary Malignancy, Andrew W. Hwang, Satvir Dhillon Md, Remus Popa

Internal Medicine

No abstract provided.

Catch 22 : To Anticoagulate Or Not To Anticoagulate, Muhammad Madkour, Patrick Hu

Internal Medicine

No abstract provided.

A Case Of Transient Complete Av Block Caused By Infective Endocarditis With Abiotrophiadefectiva, Jung Yoon Do, Wilco Civil Sr, Urvish Patel, Jermaine Ekobena, Arun Abraham, Michael Strobbe

Internal Medicine

No abstract provided.

An Unusual Case Of Broken Heart, Ammar Hasan, Enrique Rincon

Cardiology

No abstract provided.

The Palpitations That Thumped Us All:, Carolyn Falk Tran Do, Gurmanpal Sandhu Md, Daniel Robitshek Md, Tejas Raiyani Md

Internal Medicine

No abstract provided.

Moyamoya Disease Presenting With Stroke, Timothy Collins, Chimezie Ubbaonu, Phuong Vo

Internal Medicine

No abstract provided.

A Coronary Masquerade: Spontaneous Coronary Dissection Presenting As Acute Coronary Syndrome, Kara Stout Do, Stephanie Cochran Do, Abdullah Rathur Do, Joe Carragher Do, Iftekhar Baig Do, Merrill Krolick Do

Cardiology

No abstract provided.

Prognosis Of Patients With Aki After Percutaneous Mechanical Thrombectomy: A Retrospective Cohort Analysis, Hongchuan H. Coville Md, Tien-Min Lee Md, Hong Liang, Paul Alfino Md, Christopher Bray Md, Matthew Calestino Md

Internal Medicine

Percutaneous Mechanical Thrombectomy (PMT) is an endovascular procedure utilized in both arterial and venous thrombosis. Acute kidney injury (AKI) has been recognized as one undesired sequela of PMT. There is no study to investigate the outcomes in this specific patient population.

Use Of Dark Chocolate For Diabetic Patients: A Review Of The Literature And Current Evidence, Syed Raza Shah, Richard Alweis, Najla Issa Najim, Amin Muhammad Dharani, Muhammad Ahmed Jangda, Maira Shahid, Ahmed Nabeel Kazi, Syed Arbab Shah

Internal Medicine Faculty Publications

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin …