Internal Medicine Commons^™

Persistent ∆Fosb Expression Limits Recurrent Seizure Activity And Provides Neuroprotection In The Dentate Gyrus Of App Mice, Gabriel S Stephens, Jin Park, Andrew Eagle, Jason You, Manuel Silva-Pérez, Chia-Hsuan Fu, Sumin Choi, Corey P St Romain, Chiho Sugimoto, Shelly A Buffington, Yi Zheng, Mauro Costa-Mattioli, Yin Liu, A J Robison, Jeannie Chin

Faculty, Staff and Student Publications

Recurrent seizures lead to accumulation of the activity-dependent transcription factor ∆FosB in hippocampal dentate granule cells in both mouse models of epilepsy and mouse models of Alzheimer's disease (AD), which is also associated with increased incidence of seizures. In patients with AD and related mouse models, the degree of ∆FosB accumulation corresponds with increasing severity of cognitive deficits. We previously found that ∆FosB impairs spatial memory in mice by epigenetically regulating expression of target genes such as calbindin that are involved in synaptic plasticity. However, the suppression of calbindin in conditions of neuronal hyperexcitability has been demonstrated to provide neuroprotection …

The Association Of Self-Reported Sleep And Circadian Measures With Glycemic Control And Diabetes Complications Among Young Adults With Type 2 Diabetes, Dorit Koren, Kristen L Knutson, Brian K Burke, Kimberly L Drews, Fida Bacha, Lorraine Katz, Marsha D Marcus, Siripoom Mckay, Kristen Nadeau, Babak Mokhlesi, Today Study Group

Children’s Nutrition Research Center Staff Publications

We aim to examine the association of sleep duration, sleep quality, late chronotype, and circadian misalignment with glycemic control and risk of complications in young adults with youth-onset type 2 diabetes followed in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Self-reported sleep duration, quality, timing, and circadian misalignment were assessed via a modified Pittsburgh Sleep Quality Index (PSQI) questionnaire, and chronotype was assessed via the Morningness-Eveningness Questionnaire (MEQ). We examined diabetes complications including loss of glycemic control (defined as hemoglobin A1c ≥8%), hypertension, dyslipidemia, albuminuria, and diabetic peripheral neuropathy. Multivariable logistic regression models were …

Challenges And Implications For Substance Use And Mental Healthcare Among Under-Resourced Women In The Covid-19 Era, Maria C Mejia, Alicia Kowalchuk, Sandra J Gonzalez, Muktha Nair, Lisa Webb, Nadine Scamp

Faculty, Staff and Students Publications

BACKGROUND: The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes toward it, and its impact on substance use and treatment access.

METHODS: A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive …

Cystatin C Use For Ckd Detection In The Veterans Health Administration System: A Qualitative Study Of Barriers And Facilitators, Julio A Lamprea-Montealegre, Abigail Shapiro, Natalie A B Bontrager, Dena E Rifkin, Simerjot K Jassal, Lucile Parker Gregg, Sankar D Navaneethan, Krista Navarra, Michael G Shlipak, Michelle M Estrella, Virginia Wang

Faculty, Staff and Students Publications

RATIONALE & OBJECTIVE: The measurement of cystatin C has been recommended to enhance chronic kidney disease (CKD) detection and risk stratification in clinical practice. This study gathered insights into the perceptions and experiences of clinical staff regarding the use of cystatin C in CKD detection within the Veterans Health Administration (VHA) system.

STUDY DESIGN: A qualitative approach was employed to explore barriers and facilitators of clinical staff regarding the use of cystatin C in CKD detection within the VHA system. The Organizational Theory of Implementation Effectiveness informed the development of a semistructured interview guide.

SETTING & PARTICIPANTS: Health care providers, …

Identification Of Sleep Phenotypes In Copd Using Machine Learning-Based Cluster Analysis, Javad Razjouyan, Nicola A Hanania, Sara Nowakowski, Ritwick Agrawal, Amir Sharafkhaneh

Faculty, Staff and Students Publications

BACKGROUND: Disturbed sleep in patients with COPD impact quality of life and predict adverse outcomes.

RESEARCH QUESTION: To identify distinct phenotypic clusters of patients with COPD using objective sleep parameters and evaluate the associations between clusters and all-cause mortality to inform risk stratification.

STUDY DESIGN AND METHODS: A longitudinal observational cohort study using nationwide Veterans Health Administration data of patients with COPD investigated for sleep disorders. Sleep parameters were extracted from polysomnography physician interpretation using a validated natural language processing algorithm. We performed cluster analysis using an unsupervised machine learning algorithm (K-means) and examined the association between clusters and mortality …

Covid-19 Ethics: Unique Aspects And A Review As Of Early 2024, Wayne X Shandera

Faculty, Staff and Students Publications

COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of …

Autologous Her2-Specific Car T Cells After Lymphodepletion For Advanced Sarcoma: A Phase 1 Trial, Meenakshi Hegde, Shoba Navai, Christopher Derenzo, Sujith K Joseph, Khaled Sanber, Mengfen Wu, Ahmed Z Gad, Katherine A Janeway, Matthew Campbell, Dolores Mullikin, Zeid Nawas, Catherine Robertson, Pretty R Mathew, Huimin Zhang, Birju Mehta, Raksha R Bhat, Angela Major, Ankita Shree, Claudia Gerken, Mamta Kalra, Rikhia Chakraborty, Sachin G Thakkar, Olga Dakhova, Vita S Salsman, Bambi Grilley, Natalia Lapteva, Adrian Gee, Gianpietro Dotti, Riyue Bao, Ahmed Hamed Salem, Tao Wang, Malcolm K Brenner, Helen E Heslop, Winfried S Wels, M John Hicks, Stephen Gottschalk, Nabil Ahmed

Faculty, Staff and Students Publications

In this prospective, interventional phase I study (NCT00902044) for patients with advanced sarcoma, we infused autologous HER2-specific chimeric antigen receptor T-cells (HER2-CART) after lymphodepletion with cyclophosphamide (Cy) +/− fludarabine (Flu): 1×108 T-cells/m2 after Flu (cohort A) or Flu/Cy (cohort B), and 1×108 CAR-positive T-cells/m2 after Flu/Cy (cohort C). The primary outcome was assessment of safety of one dose of HER2-CART after lymphodepletion. The determination of antitumor responses was the secondary outcome. Thirteen patients were treated in 14 enrollments with 7 receiving multiple infusions. HER2-CART expanded after 19 of 21 infusions. Nine of 12 patients in cohorts A and …

Humanism Rounds: A Multifaceted "Back To Bedside" Initiative To Improve Meaning At Work For Internal Medicine Residents, Jennifer M Kaplan, Suchi Agrawal, Disha Kumar, Ann Xu, Kristen A Staggers, Anna G Symmes, Reina U Styskel, Brett Styskel, Anoop Agrawal, Stacey R Rose

Faculty, Staff and Students Publications

INTRODUCTION: Burnout is an increasingly prevalent problem among resident physicians. To address this problem, the Accreditation Council on Graduate Medical Education (ACGME) created the Back to Bedside initiative, supporting resident-driven projects focused on increasing direct interactions with patients. In 2017, Baylor College of Medicine (BCM) Internal Medicine Residency received a Back to Bedside grant to develop and implement “Humanism Rounds,” a multifaceted program which sought to promote personal connections between residents and patients and foster reflection about patients’ non-clinical stories, with the hopes of reducing burnout and increasing residents’ sense of meaning at work.

MATERIALS AND METHODS: Between 2018 and …

Unveiling The Influence Of Hyponatremia On Morbidity, Mortality, And Resource Utilization In Colorectal Carcinoma: Insights From A 5-Year Nationwide Study., Priya Hotwani Md, Vikash Kumar, Bhavyakumar Vachhani, Mrunanjali Gaddam, Jayalekshmi Jayakumar, Manasa Ginjupalli, Ankushi Sanghvi, Jincy Clement, Dhairya Nanavaty

Internal Medicine Residency

Meeting Abstract: 2024 ASCO Annual Meeting

Background: Historically, Hyponatremia has been associated with higher mortality rates and longer hospital stays in patients with solid tumors. The existing literature contains limited information on the connection between hyponatremia and Colorectal cancer (CRC). Thus, our study aimed to assess the impact of hyponatremia on mortality, morbidity, and resource usage in patients with CRC.

Methods: A retrospective analysis using the National Inpatient Sample database and International Classification of Diseases, Tenth Revision codes was conducted to examine the impact of hyponatremia on mortality, morbidity, and resource utilization in patients with CRC. Categorical variables were compared …

A Multicenter Study Of Venetoclax-Based Treatment For Patients With Richter Transformation Of Chronic Lymphocytic Leukemia, Paul J Hampel, Mahesh Swaminathan, Kerry A Rogers, Erin M Parry, Jan A Burger, Matthew S Davids, Wei Ding, Alessandra Ferrajoli, Jonathan M Hyak, Nitin Jain, Saad S Kenderian, Yucai Wang, William G Wierda, Jennifer A Woyach, Sameer A Parikh, Philip A Thompson

Faculty, Staff and Student Publications

Patients with chronic lymphocytic leukemia (CLL) who develop Richter transformation (RT) have a poor prognosis when treated with chemoimmunotherapy regimens used for de novo diffuse large B-cell lymphoma. Venetoclax, a BCL2 inhibitor, has single-agent efficacy in patients with RT and is potentially synergistic with chemoimmunotherapy. In this multicenter, retrospective study, we evaluated 62 patients with RT who received venetoclax-based treatment outside of a clinical trial, in combination with a Bruton tyrosine kinase inhibitor (BTKi; n=28), rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) (n=13), or intensive chemoimmunotherapy other than R-CHOP (n=21). The best overall and complete response rates were 36%/25%, 54%/46%, and …

Loss Of Lpar6 And Cab39l Dysregulates The Basal-To-Luminal Urothelial Differentiation Program, Contributing To Bladder Carcinogenesis, Sangkyou Lee, Jolanta Bondaruk, Yishan Wang, Huiqin Chen, June Goo Lee, Tadeusz Majewski, Rachel D Mullen, David Cogdell, Jiansong Chen, Ziqiao Wang, Hui Yao, Pawel Kus, Joon Jeong, Ilkyun Lee, Woonyoung Choi, Neema Navai, Charles Guo, Colin Dinney, Keith Baggerly, Cathy Mendelsohn, David Mcconkey, Richard R Behringer, Marek Kimmel, Peng Wei, Bogdan Czerniak

Faculty, Staff and Student Publications

We describe a strategy that combines histologic and molecular mapping that permits interrogation of the chronology of changes associated with cancer development on a whole-organ scale. Using this approach, we present the sequence of alterations around RB1 in the development of bladder cancer. We show that RB1 is not involved in initial expansion of the preneoplastic clone. Instead, we found a set of contiguous genes that we term "forerunner" genes whose silencing is associated with the development of plaque-like field effects initiating carcinogenesis. Specifically, we identified five candidate forerunner genes (ITM2B, LPAR6, MLNR, CAB39L, and ARL11) mapping near RB1. Two …

Factors Associated With Intention To Implement Sbi And Sud Treatment: A Survey Of Primary Care Clinicians In Texas Enrolled In An Online Course, Alicia Kowalchuk, Tiffany G Ostovar-Kermani, Kylie Schaper, Larissa Grigoryan, Jacqueline M Hirth, Maria Carmenza Mejia, Kiara K Spooner, Roger J Zoorob

Faculty, Staff and Students Publications

BACKGROUND: Substance use disorder (SUD) presents a range of public health challenges and consequences. Despite the prevention potential of screening and brief intervention (SBI) in the primary care setting, implementation is low. The purpose of this study was to assess associations of primary care clinicians' knowledge of SBI and SUD treatment, subjective norms, and perceived behavioral control with intention to incorporate SBI and SUD treatment into regular clinical practice.

METHODS: This online survey was administered to primary care clinicians who practice in Texas between March 1, 2021, and February 5, 2023. Survey questions were mapped to factors in the Theory …

Pulmonary Hypertension And Hyperglycemia-Not A Sweet Combination, Or Bruck, L M Pandit

Faculty, Staff and Students Publications

Hyperglycemia and pulmonary hypertension (PH) share common pathological pathways that lead to vascular dysfunction and resultant cardiovascular complications. These shared pathologic pathways involve endothelial dysfunction, inflammation, oxidative stress, and hormonal imbalances. Individuals with hyperglycemia or pulmonary hypertension also possess shared clinical factors that contribute to increased morbidity from both diseases. This review aims to explore the relationship between PH and hyperglycemia, highlighting the mechanisms underlying their association and discussing the clinical implications. Understanding these common pathologic and clinical factors will enable early detection for those at-risk for complications from both diseases, paving the way for improved research and targeted therapeutics.

Aba-Mediated Regulation Of Rice Grain Quality And Seed Dormancy Via The Nf-Yb1-Slrl2-Bhlh144 Module, Jin-Dong Wang, Jing Wang, Li-Chun Huang, Li-Jun Kan, Chu-Xin Wang, Min Xiong, Peng Zhou, Li-Hui Zhou, Chen Chen, Dong-Sheng Zhao, Xiao-Lei Fan, Chang-Quan Zhang, Yong Zhou, Lin Zhang, Qiao-Quan Liu, Qian-Feng Li

Faculty, Staff and Student Publications

Abscisic acid (ABA) plays a crucial role in promoting plant stress resistance and seed dormancy. However, how ABA regulates rice quality remains unclear. This study identifies a key transcription factor SLR1-like2 (SLRL2), which mediates the ABA-regulated amylose content (AC) of rice. Mechanistically, SLRL2 interacts with NF-YB1 to co-regulate Wx, a determinant of AC and rice quality. In contrast to SLR1, SLRL2 is ABA inducible but insensitive to GA. In addition, SLRL2 exhibits DNA-binding activity and directly regulates the expression of Wx, bHLH144 and MFT2. SLRL2 competes with NF-YC12 for interaction with NF-YB1. NF-YB1 also directly represses SLRL2 transcription. Genetic validation …

Not Your Typical Recurrent Pericarditis Patient!, Tarek Alsibai, Naomi Cret, Shaiva G. Meka

Conference Presentation Abstracts

No abstract provided.

From Immune Checkpoint Inhibition To Intubation, Sabena Toor, Samridhi Gulati, Shaiva G. Meka

Conference Presentation Abstracts

No abstract provided.

Reaction Mechanisms Of H2s Oxidation By Naphthoquinones, Kenneth R Olson, Kasey J Clear, Tsuyoshi Takata, Yan Gao, Zhilin Ma, Ella Pfaff, Anthony Travlos, Jennifer Luu, Katherine Wilson, Zachary Joseph, Ian Kyle, Stephen M Kasko, Prentiss Jones, Jon Fukuto, Ming Xian, Gang Wu, Karl D Straub

Faculty, Staff and Student Publications

1,4-naphthoquinones (NQs) catalytically oxidize H2S to per- and polysufides and sulfoxides, reduce oxygen to superoxide and hydrogen peroxide, and can form NQ-SH adducts through Michael addition. Here, we measured oxygen consumption and used sulfur-specific fluorophores, liquid chromatography tandem mass spectrometry (LC-MS/MS), and UV-Vis spectrometry to examine H2S oxidation by NQs with various substituent groups. In general, the order of H2S oxidization was DCNQ ~ juglone > 1,4-NQ > plumbagin >DMNQ ~ 2-MNQ > menadione, although this order varied somewhat depending on the experimental conditions. DMNQ does not form adducts with GSH or cysteine (Cys), yet it readily oxidizes H2S to polysulfides and sulfoxides. …

The Long-Term Effects Of Blood Urea Nitrogen Levels On Cardiovascular Disease And All-Cause Mortality In Diabetes: A Prospective Cohort Study, Hongfang Liu, Xiaoqin Xin, Jinghui Gan, Jungao Huang

Faculty, Staff and Student Publications

BACKGROUND: The long-term effects of blood urea nitrogen(BUN) in patients with diabetes remain unknown. Current studies reporting the target BUN level in patients with diabetes are also limited. Hence, this prospective study aimed to explore the relationship of BUN with all-cause and cardiovascular mortalities in patients with diabetes.

METHODS: In total, 10,507 participants with diabetes from the National Health and Nutrition Examination Survey (1999-2018) were enrolled. The causes and numbers of deaths were determined based on the National Death Index mortality data from the date of NHANES interview until follow-up (December 31, 2019). Multivariate Cox proportional hazard regression models were …

Life-Space Mobility And Cognitive Function: The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Emiri Matsuda, Michael Crowe, Virginia J. Howard, Cynthia J. Brown, Madeline R. Sterling, Emily B. Levitan

School of Medicine Faculty Publications

No abstract provided.

Mitochondria Regulate Proliferation In Adult Cardiac Myocytes, Gregory B Waypa, Kimberly A Smith, Paul T Mungai, Vincent J Dudley, Kathryn A Helmin, Benjamin D Singer, Clara Bien Peek, Joseph Bass, Lauren Nelson, Sanjiv J Shah, Gaston Ofman, J Andrew Wasserstrom, William A Muller, Alexander V Misharin, G R Scott Budinger, Hiam Abdala-Valencia, Navdeep S Chandel, Danijela Dokic, Elizabeth Bartom, Shuang Zhang, Yuki Tatekoshi, Amir Mahmoodzadeh, Hossein Ardehali, Edward B Thorp, Paul T Schumacker

Faculty, Staff and Student Publications

Newborn mammalian cardiomyocytes quickly transition from a fetal to an adult phenotype that utilizes mitochondrial oxidative phosphorylation but loses mitotic capacity. We tested whether forced reversal of adult cardiomyocytes back to a fetal glycolytic phenotype would restore proliferative capacity. We deleted Uqcrfs1 (mitochondrial Rieske iron-sulfur protein, RISP) in hearts of adult mice. As RISP protein decreased, heart mitochondrial function declined, and glucose utilization increased. Simultaneously, the hearts underwent hyperplastic remodeling during which cardiomyocyte number doubled without cellular hypertrophy. Cellular energy supply was preserved, AMPK activation was absent, and mTOR activation was evident. In ischemic hearts with RISP deletion, new cardiomyocytes …

Improving Quality Of Life In Menopausal Women Through A Best Practice Protocol: The Use Of Hormone Therapy, Mindfulness-Based Module And Exercise, Claire Czerwonka

Evidence-Based Practice Project Reports

Menopause is a normal process of aging, but many of the symptoms negatively impact women’s day-to-day quality of life (QOL), as well as activities of daily living, physical and mental health (ACOG, 2014). Generally, systemic estrogen hormone therapy is indicated for menopause-related vasomotor symptoms, but there is no research further addressing QOL issues or lifestyle management in addition to hormone therapy. The purpose of this evidence-base practice (EBP) project was to implement a menopause protocol to address QOL issues in menopausal women with the use of hormone replacement therapy, education through an online mindfulness module, and the use of exercise. …

The Unusual Suspect: Citrobacter Infection As A Rare Cause Of Renal Abscess, Nismat Javed, Nishant Allena, Sai Allu, Paul Kelly

Journal of Community Hospital Internal Medicine Perspectives

Citrobacter infections have emerged as now a common nosocomial pathogen. Most of the infections manifest in patients with underlying medical conditions. The features of infection can range from infections in the lower urinary tract, respiratory tract, gastrointestinal disease, or bacteremia, however renal abscesses remain uncommon. Here we present the case of a 48-year-old female with medical history of diabetes that presented with a right renal abscess secondary to Citrobacter koseri infection managed with drainage and antimicrobial treatment.

The Not-So-Benign Sickle Cell Trait: A Case Of Renal Medullary Carcinoma, Fatima Halilu, Siddartha Guru, Fuscaldo Joseph

Journal of Community Hospital Internal Medicine Perspectives

Sickle cell trait (SCT) has long been considered a benign carrier state with malarial protection, but carriers can be affected by increased venous thromboembolism, exercise-related injury, renal complications and very rarely a fatal renal malignancy. Renal medullary carcinoma is a very rare and aggressive renal tumor described almost exclusively in sickle cell trait. A review of the current literature provides clues to this link and describes trends expected in these cases. We report a case of renal medullary carcinoma in a 32-year-old female with known sickle trait who presented with cough, hemoptysis, left flank pain and gross hematuria. Initial presentation …

Role Of Artificial Intelligence In Endoscopic Intervention: A Clinical Review, Nismat Javed, Haider Ghazanfar, Bhavna Balar, Harish Patel

Journal of Community Hospital Internal Medicine Perspectives

Gastrointestinal diseases are increasing in global prevalence. As a result, the contribution to both mortality and healthcare costs is increasing. While interventions utilizing scoping techniques or ultrasound are crucial to both the timely diagnosis and management of illness, a few limitations are associated with these techniques. Artificial intelligence, using computerized diagnoses, deep learning systems, or neural networks, is increasingly being employed in multiple aspects of medicine to improve the characteristics and outcomes of these tools. Therefore, this review aims to discuss applications of artificial intelligence in endoscopy, colonoscopy, and endoscopic ultrasound.

A Multi-Modal Intervention To Decrease Hpv Vaccine Hesitancy And Increase Uptake In Young Adult Women, Rylee Cartales

Evidence-Based Practice Project Reports

Human Papillomavirus (HPV) is the leading cause of cervical cancer worldwide and the most common sexually transmitted disease, yet hesitancy towards the HPV vaccine remains high and uptake of the HPV vaccine remains remarkably low (CDC, 2021b). The purpose of this evidence-based practice (EBP) project was to determine if the implementation of a multimodal intervention including a motivational interview, strong provider recommendation, and educational materials will decrease HPV vaccine hesitancy and consequentially increase uptake of the vaccine. Eleven young adult women ages 18-26 from a rural outpatient Obstetrics and Gynecology (OBGYN) clinic in Indiana participated in this project. After agreeing …

Assessing Quality Of Health-Related Social Needs Screening Across Jefferson Hospital’S Clinical Sites, Aparna Sarin, Md, Mph, Olivia Quinn, Mph, Nolan Chiles, Bs

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Assess the rate of completed health-related social needs (HRSNs) screenings at different TJUH sites
• Compare screening outcomes across TJUH clinical sites

Background

- Centers for Medicare and Medicaid (CMS) is mandating Health Related Social Needs (HRSNs) screening for all admitted patients

- First-year Sidney Kimmel Medical College (SKMC) students screen patients at four different Jefferson clinical sites alongside Community Health Workers (CHWs) as part of their ‘Clinical Experience’ curriculum

- SKMC screens 7 domains

• Food*
• Housing*
• Utilities*
• Transportation*
• Medication expenses
• Primary care
• Insurance
  
  *Screened by CMS, as well as interpersonal safety

- The data is gathered from:

• inpatient floors …

Effect Of Education Level On Adequacy Of Bowel Preparation Prior To Colonoscopy, Anna Chen, Md, Michael Dimarino, Md, Akash Patel, Do, Katherine Duffey, Md, Gregory Habig, Md, Aaron Martin, Md, Cuckoo Choudhary, Md, Stephanie Moleski, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Adequate bowel preparation is crucial for obtaining a high-quality colonoscopy.
• Inadequate preparation leads to impaired visualization, which can lower adenoma detection rate, increase the risk of complications and potentially necessitate repeating the procedure.¹
• Patients with higher health literacy and a higher level of education have been associated with better bowel preparation quality.^2,3,4,5

Increasing Hpv Vaccination Rates In Residents' Primary Care Clinics, Normonique Dyer, Do, Amman Bhasin, Md, Abdul Ekiyoyo, Md, Umma Fatema, Md, Ilana Goldberg, Md, Chukwuemezie Mamanu, Md, Tamar Wolinsky, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• The human papillomavirus (HPV) vaccine was approved in 2014 for the prevention of anogenital, cervical, and oropharyngeal cancers in female and male adolescents up to 26 years of age^1,2
• Data compiled from multiple clinical trials performed between 2006 and 2018 sought to evaluate benefit from extending the vaccination age given the implications on improving quality of life, morbidity/mortality, and reducing overall healthcare costs for preventable diseases³
• Results showed that increasing the vaccination age up to 45 in both males and females could offer additional protections against high-risk oncogenic strains of the HPV virus3
• Current recommendations from the …

Procedural Realignment To Ensure Superb Hypertension Regulation: The Presher Study, Eleni Florakis, Md, Emily Khantses, Md, Bret Mccarty, Md, Jeffrey White, Md, Jason Ojeda, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition

Hypertension (HTN), defined by the American Heart Association as systolic blood pressure (SBP) over 130 mm Hg or diastolic blood pressure (DBP) over 80 mm Hg, remains a major health concern worldwideas it leads tocongestive heart failure, chronic kidney disease, and stroke. Blood pressure control is an important task for the primary care physician (PCP). However, adequate management remains suboptimal as nearly half of US adults have uncontrolled high blood pressure.

After reviewing selected patients in our primary care office and discussing with our stakeholders, we found that more than two-thirds (69%) of uncontrolled hypertensive patients from a …

Nsaids Role In Triggering Ibd Exacerbations; Reality Or Misunderstanding? A Systematic Review, Alec Swartz, Malitha Hettiarachchi

Conference Presentation Abstracts

Introduction: Initial studies seemed to show that NSAID use was associated with increased risk of IBD exacerbation. Supported by known role of COX-1/2 isoenzymes (specifically their prostaglandin [PG] products) in maintaining GI mucosal barrier and mediating inflammation Combination of early research findings and COX prostaglandin knowledge resulted in NSAID avoidance in IBD patients. Recent data seemingly contradicts prior research, and NSAID use is predicted to not play a role in IBD exacerbation Methods: We conducted a systematic review of the literature using PubMed and American Journal of Gastroenterology. Of the thousands of results, we narrowed our results to 4 recent …