Internal Medicine Commons^™

“Medical Cannabis”: Advising Patients While Navigating Medical Ethics And Limited Evidence, Anna-Maria South, Shanna L. Babalonis, Laura C. Fanucchi, Michelle R. Lofwall

Internal Medicine Faculty Publications

Cannabis is increasingly legalized in more areas of the USA and marketed under the misnomer “medical cannabis.” Yet, there are no official dosing guidelines or approved medical uses for plant cannabis by the Food and Drug Administration. Due to significant federal barriers, research on efficacy, safety, and adverse effects of cannabis is limited. Patients are interested in cannabis as potential treatment of medical issues and/or symptoms and clinicians should include a discussion of the risks of cannabis consumption. However, many risks are not yet known, and clinicians might be unaware of the emerging literature. This perspective summarizes the potential harms …

Prevalence And Characteristics For Mental Health Disorder Before And After Childhood Cancer Diagnosis—A Statewide Population-Based Study Among Medicaid Beneficiaries, Feitong Lei, Laurie E. Mclouth, Eric B. Durbin, Thomas T. Tucker, John L. Villano, Bin Huang

Internal Medicine Faculty Publications

Introduction: Pediatric cancer patients suffer mental health deficits. Patients who are vulnerable with respect to socioeconomic or other sociodemographic factors may be at heightened risk for worse mental health outcomes during cancer for many reasons including entering treatment with an existing mental health disorder. The purpose of this study was to describe the prevalence and trajectory of mental health before and after a childhood cancer diagnosis in a socio-demographically at-risk sample.

Methods: Data from the Kentucky Cancer Registry was utilized to identify patients aged 19 or under with a first primary childhood cancer diagnosis during 2001–2017. Linking KCR data with …

Facilitators Of And Barriers To Implementation Of A Tablet-Based Digital Health Program For Colorectal Cancer Screening In Primary Care: Qualitative Pragmatic Implementation Study, Mark Cromo, Aliza Randazzo, David P. Miller, Kristie Foley, Ajay Dharod, Anna C. Snavely, Elena Wright, Holly Brower, Mark Dignan

Internal Medicine Faculty Publications

Background: Colorectal cancer (CRC) incidence and mortality rates continue to be elevated even though effective screening methods are widely available. To increase CRC screening in primary care practices, our team developed a tablet-based digital health program (mPATH) designed to identify patients needing CRC screening, provide education, and empower patients to request a screening test via the program.

Objective: This study aimed to qualitatively assess facilitators of and barriers to implementing and maintaining mPATH in primary care clinics.

Methods: In a pragmatic implementation trial, clinics were randomized to receive only in-person training and technological support via phone or email (low touch) …

Adipose Tissue-Derived Small Extracellular Vesicles In Plasma Reveal Molecular Circuitries Underlying Glucose Intolerance, Shalini Mishra, Yixin Su, Ashish Kumar, Sangeeta Singh, Brian S. Finlin, Fang-Chi Hsu, Jingyun Lee, Cristina M. Furdui, Philip A. Kern, Swapan K. Das, Gagan Deep

Internal Medicine Faculty Publications

Objective: Glucose tolerance (GT) is a major effector for adipose tissue (AT) remodeling in obesity, yet its molecular mechanisms remain incompletely defined. We hypothesized that the biophysical and molecular profiles of AT-derived small extracellular vesicles (sEV^AT) change in response to glucose availability and differ by GT status.

Methods: sEV^AT were isolated from plasma of individuals with normal GT (NGT) and impaired GT (IGT) (n = 5/group) at fasting (0 h) and 1 h post glucose challenge during oral glucose tolerance test (OGTT). sEV^AT were characterized for size, concentration, surface expression of insulin receptor-α (INSRα), proteome, …

Difficult-To-Treat Rheumatoid Arthritis With Concomitant Yao Syndrome With Response To Dual-Inhibitor Therapy, Nawar Aljundi, Paramarajan Piranavan

Internal Medicine Faculty Publications

No abstract provided.

An Unbiased Molecular Characterization Of Peripartum Cardiomyopathy Hearts Identifies Mast Cell Chymase As A New Diagnostic Candidate, J. F. Mulvey, C. Sailer, J. S. Achter, Gregory Nathaniel Milburn, R. C. Bretherton, K. Kahnert, S. Erbil Bilir, H. Hvid, C. Pyke, F. Gustafsson, L. Adamo, Kenneth S. Campbell, K. M. Herum, A. Lundby

Internal Medicine Faculty Publications

Peripartum cardiomyopathy (PPCM) is a rare form of acute heart failure that develops in women toward the end of pregnancy or early postpartum. No effective, specific treatment for PPCM is available and heart transplantation or mechanical circulatory support may be required in severe cases where drug treatment for heart failure is insufficient. The mechanisms through which the disease progresses are not well understood, and despite similar clinical characteristics to dilated cardiomyopathy of other etiologies (nonperipartum cardiomyopathy; NPCM) it is not known how the molecular remodeling differs between these groups. We aimed to provide insight into the human PPCM heart using …

Flipping The Curriculum For Resident Didactics: In-Training And Certifying Examination Scores In An Internal Medicine Residency, Luke Mccoy, Ronald J. Markert, Elysha Thoms, Olivia Noall, Kathryn Burtson

Internal Medicine Faculty Publications

Purpose The flipped classroom (FC) model is increasingly used in undergraduate medical education, where it has been associated with improved knowledge acquisition. However, its impact on graduate medical education (GME) remains underexplored. We hypothesized that implementing a flipped didactics curriculum in our internal medicine residency program would improve performance on the Internal Medicine In-Training Examination (IM-ITE) and the American Board of Internal Medicine Certifying Examination (IM-CE). Methods In 2017, we transitioned from a traditional lecture-based (LB) curriculum to a flipped model. Noon conferences were replaced with problem-based learning (PBL) sessions three days per week, with additional active learning formats used …

All-Cause And Exacerbation-Related Readmissions In Thrombotic Microangiopathy Requiring Plasmapheresis: A Population-Based Cohort Study, Alexander R. Thebert, Toru Yoshino, Sae X. Morita, Misa Ito, Ayman Qasrawi, Hirotaka Kato

Internal Medicine Faculty Publications

Objective: Thrombotic microangiopathy (TMA) is a serious condition characterized by microangiopathic hemolytic anemia and thrombocytopenia, with high exacerbation rates. This study examined all-cause and exacerbation-related readmission risks among patients hospitalized with TMA requiring plasmapheresis.

Materials and Methods: Secondary analysis of the 2020 Nationwide Readmission Database was conducted, including discharge data from non-federal hospitals in 31 U.S. states. Patients aged 18 years or older admitted non-electively with a primary or secondary diagnosis of TMA requiring plasmapheresis were included. Exacerbation-related readmission was defined as subsequent admission requiring plasmapheresis within 7 or 30 days after the original discharge. Multivariable logistic regression and Cox …

Clonal Hematopoiesis Of Indeterminate Potential And The Risk Of Cognitive Impairment In The Women’S Health Initiative Memory Study, Yasminka A. Jakubek, Aaron P. Smith, Xiaoyan I. Leng, Megan E. Hall, Daniel Ezzat, Yash Pershad, Jason M. Collins, Md Mesbah Uddin, David W. Fardo, Pradeep Natarajan, Alexander G. Bick, Jacob O. Kitzman, Michael C. Honigberg, Kathleen M. Hayden, Joann E. Manson, Siddhartha Jaiswal, Eric A. Whitsel, Alexander P. Reiner

Internal Medicine Faculty Publications

INTRODUCTION

Clonal hematopoiesis of indeterminate potential (CHIP) confers an increased risk of several chronic aging-related diseases. Paradoxically, CHIP was associated with lower risk of dementia in recent studies.

METHODS

We examined associations between baseline CHIP and incident mild cognitive impairment (MCI) and/or probable dementia in the Women's Health Initiative Memory Study. CHIP was detected using blood-based targeted sequencing. Cox proportional hazards models examined time to onset of cognitive impairment, adjusting for traditional risk factors.

RESULTS

Using a conventional variant allele fraction (VAF) threshold of 2%, CHIP was not associated with incident cognitive impairment. The presence of larger CHIP clone (VAF …

Dual Biologic Therapy Induces Remission In Refractory Crohn’S Disease With Vedolizumab And Ustekinumab, Syed Adeel Hassan, Courtney Perry, Patrick Carey, Durham Colohan, Mohamed Gebril Eltaher, Nabila Dawoud, Mahmoud Elkammar, Waqas Rasheed, Casie Mayne, Amy Stuffelbeam, Deborah R. Auer Flomenhoft, Terrence A. Barrett

Internal Medicine Faculty Publications

Background

Despite advancements in the therapeutic armamentarium for Crohn’s disease (CD), biologic and small molecule monotherapies are associated with sub-optimal response and remission rates. Utilizing dual biologic therapy (DBT) holds the potential to increase efficacy in the treatment of refractory or partially responsive CD. Evidence pertaining to this strategy remains limited. Methods

We retrospectively examined refractory CD patients treated with a combination of ustekinumab and vedolizumab. Outcomes to DBT at week (wk) 52 were compared to monotherapy. The primary outcome constituted corticosteroid-free remission. Secondary outcomes included adverse events, infections, hospitalizations, surgeries, treatment persistence, and disease clearance. Results

Sixteen of 21 …

Barriers To Adherence To Standard Of Care In Appalachia: A Qualitative Assessment In Gastrointestinal Cancers, Brittany Levy, Jennifer T. Castle, Roshmita Bardhan, Mark Dignan, Avinash S. Bhakta

Internal Medicine Faculty Publications

Purpose: Appalachian Kentucky, a 32-county region in the eastern part of the state, has elevated colon cancer mortality rates. While recommended as the standard of care, access to adjuvant chemotherapy treatment is limited in this region due to scarce health services and significant social and geographical barriers. The purpose of this investigation was to improve understanding of barriers that cancer patients residing in rural areas not served directly by tertiary medical systems must overcome in completing adjuvant therapy.

Methods: Participants were recruited from two medical centers: A tertiary care NCI designated Cancer Center and a regional hospital. Participants underwent a …

Circulating Molecular Drivers Of Bone Remodeling In Pancreatitis, Rachel L. Hill, Dhiraj Yadav, Phil A. Hart, David C. Whitcomb, Kristen J. Mcquerry, Kelsey N. Karnik, Kimberly M. Stello, Darwin L. Conwell, Madhumathi Rao

Internal Medicine Faculty Publications

INTRODUCTION: 

Pancreatitis-associated osteopathy is a clinically significant but mechanistically underexplored complication of pancreatic disease. We aimed to characterize stage-specific alterations in bone remodeling biomarkers across the spectrum of disease: recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP).

METHODS: 

In a cross-sectional analysis of North American Pancreatitis Study 2 participants, we measured serum mechanistic (sclerostin, dickkopf-1, receptor activator of nuclear factor κβ ligand, and osteoprotegerin), hormonal (fibroblast growth factor 23, insulin, and leptin), and modulatory (osteopontin, oncostatin, and osteoactivin) markers in controls (n = 30), RAP (n = 40), and CP (n = 40) using a multiplex assay. Group differences were …

Digital Health Interventions For Colorectal Cancer Screening Uptake: A Scoping Review, Sujin Kim, Andrew J. Whipkey, Jihye Bae, Avinash S. Bhakta

Internal Medicine Faculty Publications

Digital health interventions (DHIs) are increasingly employed to improve colorectal cancer (CRC) screening uptake, yet comprehensive syntheses of their effectiveness across diverse contexts remain scarce. This scoping review examines how individual, contextual, technological, and timing-related factors shape CRC screening outcomes in DHI-based trials. Following PRISMA-ScR guidelines, we conducted a systematic search of PubMed, Google Scholar, and ClinicalTrials.gov from March 1 to April 20, 2024, identifying 4,523 records through databases and an additional 2,039 through backward citation tracking. After deduplication and screening, 51 studies were included and charted using the PICOT (Population, Intervention, Comparison, Outcome, and Timing) framework. Included studies spanned …

Early-Onset Bevacizumab-Associated Knee Osteonecrosis In A Young Adult With Astrocytoma, Chandra L. Kakarala, Nicole A. Lisek, Clyde Coleman, John L. Villano, Katherine L. Copely, Patricia A. Santos

Internal Medicine Faculty Publications

We describe a rare case of knee osteonecrosis in a 22-year-old man with astrocytoma and neurofibromatosis type 1 after short-term treatment with bevacizumab and corticosteroids. Magnetic resonance imaging (MRI) identified infarctions and osteonecrosis of the distal femur and proximal tibia. Osteonecrosis associated with bevacizumab is typically limited to the jaw; this case highlights the potential for earlier, extra-jaw involvement. Clinicians should maintain a high index of suspicion for osteonecrosis in patients on vascular endothelial growth factor inhibitors, especially with concurrent steroid use, and consider prompt MRI in the evaluation of unexplained joint pain.

Harmonizing Data Across The Accelerating Colorectal Cancer Screening And Follow-Up Through Implementation Science (Accsis) Program To Enhance Data Quality And Promote Data Sharing., Sujha Subramanian, Sarah Kobrin, Sonja Hoover, Sylvia Tan, Alison T. Brenner, Janis E. Campbell, Jennifer Hatcher, Bin Huang, Madeleine Jones, Erin S. Kenzie, Helen Lam, David Liebovitz, Shiraz I. Mishra, Meghan C. O'Leary, Kristine N. Ortwine, V. Shane Pankratz, Electra D. Paskett, Michael Pennell, Amanda F. Petrik, Scott Roesch

Internal Medicine Faculty Publications

BACKGROUND: The purpose of the Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) Program, a Cancer Moonshot℠ Initiative, is to support research to build the evidence base on multilevel interventions that increase rates of colorectal cancer screening, follow-up, and referral to care to address disparities in colorectal cancer screening. The National Cancer Institute funded eight Research Projects to implement multilevel interventions to improve colorectal cancer screening among communities who traditionally have been medically underserved. To analyze the impact of ACCSIS across Research Projects, the consortium developed a set of common data elements. The purpose of this paper is …

A Digital Twin Of The Infant Microbiome To Predict Neurodevelopmental Deficits., Nicholas Sizemore, Kaitlyn Oliphant, Ruolin Zheng, Camilia R Martin, Erika C Claud, Ishanu Chattopadhyay

Internal Medicine Faculty Publications

Despite the recognized gut-brain axis link, natural variations in microbial profiles between patients hinder definition of normal abundance ranges, confounding the impact of dysbiosis on infant neurodevelopment. We infer a digital twin of the infant microbiome, forecasting ecosystem trajectories from a few initial observations. Using 16S ribosomal RNA profiles from 88 preterm infants (398 fecal samples and 32,942 abundance estimates for 91 microbial classes), the model (Q-net) predicts abundance dynamics with R² = 0.69. Contrasting the fit to Q-nets of typical versus suboptimal development, we can reliably estimate individual deficit risk (M_δ) and identify infants …

Intensivist -Driven Ventilator Management Shortens Duration Of Mechanical Ventilation In Coronary Artery Bypass Graft Surgery Patients, Yonatan Dollin, Brian Elliott, Ronald J. Markert, Angela Morman, Matthew Koroscil

Internal Medicine Faculty Publications

Background Prolonged mechanical ventilation in post Coronary Artery Bypass Graft Surgery (CABG) is associated with deleterious effects including, increased ICU and hospital length of stay (LOS), infectious complications, and mortality. Standardized ventilator weaning protocols and the utilization of critical care physicians in post CABG patient care vary substantially among institutions. The purpose of this study was to evaluate if intensivist consultation in conjunction with a multidisciplinary, standardized ventilator weaning protocol improves outcomes in CABG patients. Materials and Methods We performed a single-center, retrospective, before-after cohort analysis at Miami Valley Hospital in Dayton, OH, a 970-bed community hospital. Patients were divided …

Bamlanivimab Use In A Military Treatment Facility, Eric Karr, Theodore Chung, Kathryn Burtson, Ronald J. Markert, Devin Kelly

Internal Medicine Faculty Publications

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), was first identified in 2019 in Wuhan, China, and has rapidly spread across the world. As of April 2021, SARS-CoV-2 has infected more than 140,000,000 and caused more than 3,000,000 deaths globally. In November 2020, the monoclonal antibody bamlanivimab was approved by the FDA for non-hospitalized patients with SARS-CoV-2 (COVID-19) who possessed risk factors for progression to severe COVID-19. This provided a treatment option that may help prevent hospitalization. Methods Patients who regularly received ambulatory care at a military treatment facility and who were …

Impact Of An Education Intervention On Covid-19 Vaccine Hesitancy In A Military Base Population, Peter C. Li, Samuel R. Theis, Devin Kelly, Col Thad Ocampo, Andrew Berglund, Damien Morgan, Ronald J. Markert, Evan Fisher, Kathryn Burtson

Internal Medicine Faculty Publications

Background: Coronavirus disease 2019 (COVID-19) vaccine hesitancy is a major impediment to achieving herd immunity and overcoming the current pandemic. Our aim was to decrease the prevalence of vaccine hesitancy through an education intervention. Method: An education intervention, consisting of a PowerPoint presentation addressing the two mRNA COVID-19 vaccine concerns/myths and a question and answer panel comprising health care providers from various specialties, was implemented to address vaccine hesitancy among personnel associated with Wright-Patterson Air Force Base through a series of virtual and in-person seminars. Participants completed a post-seminar survey as a retrospective self-assessment to identify attitudes and views surrounding …

Perceptions And Concerns Regarding Covid-19 Vaccination In A Military Base Population, Samuel R. Theis, Peter C. Li, Devin Kelly, Thad Ocampo, Andrew Berglund, Damien Morgan, Ronald J. Markert, Evan Fisher, Kathryn Burtson

Internal Medicine Faculty Publications

Introduction: Safe and effective vaccines against severe acute respiratory syndrome-associated coronavirus 2 are essential tools in the fight against the coronavirus disease 2019 (COVID-19) pandemic. However, hesitancy to vaccination is a major barrier to achieving herd immunity, particularly among a population working on a military base. To better understand the perceptions and concerns of these individuals, a voluntary survey was conducted. Materials and methods: An interactive, online survey was constructed and disseminated to individuals associated with Wright-Patterson Air Force Base (WPAFB) in Dayton, OH. Survey participation was voluntary with responses collected over the initial weeks in which WPAFB began to …

Adipocyte-Derived Serum Amyloid A Promotes Angiotensin Ii–Induced Abdominal Aortic Aneurysms In Obese C57bl/6j Mice, Preetha Shridas, Ailing Ji, Andrea C. Trumbauer, Victoria P. Noffsinger, Steve W. Leung, Adam J. Dugan, Sean E. Thatcher, Lisa A. Cassis, Frederick C. De Beer, Nancy R. Webb, Lisa R. Tannock

Internal Medicine Faculty Publications

Background: Obesity increases the risk for human abdominal aortic aneurysms (AAAs) and enhances Ang II (angiotensin II)-induced AAA formation in C57BL/6J mice. Obesity is also associated with increases in perivascular fat that expresses proinflammatory markers including SAA (serum amyloid A). We previously reported that deficiency of SAA significantly reduces Ang II-induced inflammation and AAA in hyperlipidemic apoE-deficient mice. In this study. we investigated whether adipose tissue-derived SAA plays a role in Ang II-induced AAA in obese C57BL/6J mice.

Methods: The development of AAA was compared between male C57BL/6J mice (wild type), C57BL/6J mice lacking SAA1.1, SAA2.1, and SAA3 …

Autologous Haematopoietic Stem Cell Transplantation And Systemic Sclerosis: Focus On Interstitial Lung Disease, Gianluca Bagnato, Antonio Giovanni Versace, Daniela La Rosa, Alberta De Gaetano, Egidio Imbalzano, Marianna Chiappalone, Carmelo Ioppolo, William Neal Roberts, Alessandra Bitto, Natasha Irrera, Alessandro Allegra, Giovanni Pioggia, Sebastiano Gangemi

Internal Medicine Faculty Publications

Autologous hematopoietic stem cells transplantation (AHSCT) has been employed as treatment for severe systemic sclerosis (SSc) with high risk of organ failure. In the last 25 years overall survival and treatment-related mortality have improved, in accordance with a better patient selection and mobilization and conditioning protocols. This review analyzes the evidence from the last 5 years for AHSCT-treated SSc patients, considering in particular the outcomes related to interstitial lung disease. There are increasing data supporting the use of AHSCT in selected patients with rapidly progressive SSc. However, some unmet needs remain, such as an accurate patient selection, pre-transplantation analysis to …

Management Of Infective Endocarditis In Pregnancy By A Multidisciplinary Team: A Case Series, Kayle S. Shapero, Varidhi Nauriyal, Christina Megli, Kathryn Berlacher, Sami El-Dalati

Internal Medicine Faculty Publications

Introduction: The incidence of infective endocarditis (IE) in pregnancy is rare and has been increasing during the opioid epidemic. IE in pregnancy is associated with high rates of maternal and fetal morbidity and mortality. Multidisciplinary endocarditis teams for management of IE have been shown to reduce in-hospital and 1-year mortality. We present a single-center experience managing IE in pregnancy utilizing a multidisciplinary endocarditis team.

Methods: Patients diagnosed with IE while pregnant or within 30 days post-partum were identified. All patients discussed at the institution's weekly multidisciplinary endocarditis meeting were included. Demographic and clinical data and outcome-related variables were retrospectively reviewed …

Emerging Evidence And Treatment Perspectives From Randomized Clinical Trials In Systemic Sclerosis: Focus On Interstitial Lung Disease, Caterina Oriana Aragona, Antonio Giovanni Versace, Carmelo Ioppolo, Daniela La Rosa, Rita Lauro, Maria Concetta Tringali, Simona Tomeo, Guido Ferlazzo, William Neal Roberts, Alessandra Bitto, Natasha Irrera, Gianluca Bagnato

Internal Medicine Faculty Publications

Systemic sclerosis (SSc) is a complex rare autoimmune disease with heterogeneous clinical manifestations. Currently, interstitial lung disease (ILD) and cardiac involvement (including pulmonary arterial hypertension) are recognized as the leading causes of SSc-associated mortality. New molecular targets have been discovered and phase II and phase III clinical trials published in the last 5 years on SSc-ILD will be discussed in this review. Details on the study design; the drug tested and its dose; the inclusion and exclusion criteria of the study; the concomitant immunosuppression; the outcomes and the duration of the study were reviewed. The two most common drugs used …

Recent Advances In Probiotic Application In Animal Health And Nutrition: A Review, Sarayu Bhogoju, Samuel Nahashon

Internal Medicine Faculty Publications

Biotechnological advances in animal health and nutrition continue to play a significant role in the improvement of animal health, growth, and production performance. These biotechnological advancements, especially the use of direct-fed microbials, also termed probiotics, those genetically modified and otherwise, have minimized many challenges facing livestock production around the world. Such advancements result in healthy animals and animal products, such as meat, for a growing population worldwide. Increasing demand for productivity, healthy animals, and consumer food safety concerns, especially those emanating from excessive use of antibiotics or growth promoters, are a driving force for investing in safer alternatives, such as …

Tracking Sentiments Toward Fat Acceptance Over A Decade On Twitter, Sadie Bograd, Benjamin Chen, Ramakanth Kavuluru

Internal Medicine Faculty Publications

The fat acceptance (FA) movement aims to counteract weight stigma and discrimination against individuals who are overweight/obese. We developed a supervised neural network model to classify sentiment toward the FA movement in tweets and identify links between FA sentiment and various Twitter user characteristics. We collected any tweet containing either “fat acceptance” or “#fatacceptance” from 2010–2019 and obtained 48,974 unique tweets. We independently labeled 2000 of them and implemented/trained an Average stochastic gradient descent Weight-Dropped Long Short-Term Memory (AWD-LSTM) neural network that incorporates transfer learning from language modeling to automatically identify each tweet’s stance toward the FA movement. Our model …

A Retrospective Cohort Study Assessing Acute Kidney Injury And Renal Recovery Among Septic Patients Empirically Treated With Vancomycin Piperacillin–Tazobactam Versus Vancomycin Cefepime, Brian Pacca Elliott, Michael M. Tang, Joshua Alexander Madden, Ronald J. Markert, Steven Dale Burdette, Craig Matthew Pleiman, Emily Claire Speelmon

Internal Medicine Faculty Publications

Vancomycin plus piperacillin-tazobactam (VPT) is a commonly used antimicrobial regimen for septic patients. VPT is more nephrotoxic than other regimens such as vancomycin plus cefepime (VC) when given over several days. This risk of nephrotoxicity is less clear when VPT is given for initial empiric therapy in sepsis and de-escalated quickly based on evolving clinical information. The objective of this study was to assess nephrotoxicity among septic patients empirically treated with either VPT or VC at initial clinical presentation. We conducted a retrospective study of septic patients who received VPT or VC within 12 h of presentation to the emergency …

Whistling Scrotum: An Unusual Presentation Of Pneumomediastinum In The Setting Of An Open Scrotal Wound, Brant Bickford, Andrew J. Berglund, Ronald J. Markert, Hari Polenakovik

Internal Medicine Faculty Publications

BACKGROUND Pneumoscrotum is a rare clinical occurrence in which air accumulates in the scrotum. The origin of air is primarily from trauma, but spontaneous pneumoscrotum can develop from gastrointestinal or pulmonary sources. Physical examination of pneumoscrotum typically includes crepitus of the perineal region and scrotal swelling and associated findings depending on the origin of the free air. However, pneumoscrotum in the setting of a scrotal wound, which allows air to pass freely outside the body, has not been previously documented in the literature. CASE REPORT A 72-year-old man who recently underwent a scrotal incision and drainage for recurrent epididymitis presented …

Self- Vs Provider-Referral Differences For Coronary Artery Calcium Testing, Rebekah Lantz, Steve Young, Janet Lubov, Anas Ahmed, Ronald J. Markert, Srikanth Sadhu

Internal Medicine Faculty Publications

Study objectives: The objectives of this study were to identify independent predictors for moderate/accentuated coronary artery calcium (CAC) score and compare patients who self-referred for CAC Computed Tomography (CT) testing to those who were provider-referred. Design: Patients underwent CAC between January to July 2019. The analysis was divided into self-referred patients influenced by a CAC community campaign who identified themselves as having cardiovascular risk factors compared to provider-referred intermediate-risk patients who were asymptomatic. SAS version 9.4 (SAS Institute, Inc., Cary, NC) was used for all analyses. Setting: Seven southwest Ohio hospitals from a single network. Participants: 2124 adult patients who …

The Efficacy Of Sequential Biologic Agents In Refractory Rheumatoid Arthritis After Failure Of Initial Dmard And Anti-Tumor Necrosis Factor Therapy, Antonio Giovanni Versace, Caterina Oriana Aragona, Daniela La Rosa, Marianna Chiappalone, Maria Concetta Tringali, Alberta De Gaetano, Charles Frederick Moore Jr., Donatella Sangari, William Neal Roberts, Gianluca Bagnato

Internal Medicine Faculty Publications

Introduction/Objective: The efficacy of biologic therapy in the treatment of rheumatoid arthritis (RA) has been well-established but, in practice, a quarter of patients will either not respond to the first biologic agent or will suffer an adverse event requiring a switch to a different drug. While clinical guidelines exist to help guide therapy and previous studies have examined sequential use of anti-TNF agents, there is little data to inform a multiple switch strategy. Our aim was to measure the efficacy of multiple switches of biologic in severe refractory RA. Methods: We enrolled 111 patients whose therapy with one anti-TNF agent …