International Public Health Commons^™

A Proposal For Developing Academic Partnerships Between American Clinical Institutions And Ngos, Anik Patel, Nahreen Ahmed, Alfredo Mena Lora, Riley Jones

Posters

"Humanitarian and health-focused non-governmental organizations, such as MedGlobal, and American clinical institutions can mutually benefit from the formation of academic partnerships. MedGlobal has a longitudinal presence in ongoing humanitarian disasters that can provide rich clinical experiences for academic institutions looking to provide more diverse and equity-driven training for its residents and fellows. American institutions can provide resources, personnel with special skills and knowledge, as well as research assistance to MedGlobal and its partner sites as it continues to promote evidence-based clinical care for refugees. We propose an innovative model that addresses 3 areas of opportunities: education, research/QI, and clinical care. …

Pulmonary Inflammation And Injury Triggered By Spine Surgery In Recovered Covid-19 Patients Demand Consideration, Luciano Rodrigo Lopes, Silvana Kertzer Kasinski

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Why Should People Use Face Masks In The Time Of Covid? The Jri Position, Jose Bordon, Alex Glynn, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

No Difference In Clinical Outcomes For African American And White Patients Hospitalized With Sars-Cov-2 Pneumonia In Louisville, Kentucky, Julio A. Ramirez, Stephen P. Furmanek, Thomas Chandler, Stephen S. Hanson, Dawn Balcom, Subathra Marimuthu, Sathya Krishnasamy, Jose Bordon, Rodrigo Cavallazzi, Amr Aboelnasr, Mahder A. Tella, William A. Mattingly, Ashley M. Wilde, Daisy Sangroula, Demetra Antimisiaris, Donghoon Chung, Guillermo Cabral, Gabino R Fernandez-Botran, Jiapeng Huang, Martin Gnoni, Ozan Akca, Paul Schulz, Phillip F. Bressoud, Priya Krishnan, Sally Suliman, William P. Mckinney, Bryan Moffett, Leslie A Wolf, Mark Burns, Alex Glynn, Ruth Carrico, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Introduction: Current literature indicates that African American individuals are at increased risk of becoming infected with the SARS-CoV-2 virus and suffer higher SARS-CoV-2-related mortality rates. However, there is a lack of consensus as to how the clinical outcomes of African American patients differ from those of other groups. The objective of this study was to define the clinical outcomes of African American and White hospitalized patients with SARS-CoV-2 community-acquired pneumonia (CAP) in Louisville, Kentucky.

Methods: This was a retrospective cohort study of hospitalized patients with SARS-CoV-2 CAP at eight hospitals in Louisville, Kentucky. Severity of CAP at time of hospitalization …

Baricitinib In The Treatment Of A Critical Patient With Covid-19 Pneumonia: A Case Report, Nishant Patel, Dylan Goldsmith, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

A 72-year-old male presented to the emergency department with a chief complaint of diarrhea after having tested positive for COVID-19 two days prior. He initially had minimal respiratory complaints, but was eventually transferred to the intensive care unit for acute hypoxic respiratory failure. In addition to dexamethasone, remdesivir, and antibiotics, the patient was treated with baricitinib, a Janus kinase inhibitor that was recently granted emergency use authorization by the Food and Drug Administration for treatment of hospitalized patients with COVID-19. He had an extensive and complicated hospital course and had to be placed on mechanical ventilation, ultimately undergoing tracheostomy. After …

Streptococcus Anginosus Lung Infection And Empyema: A Case Report And Review Of The Literature, Nishita Tripathi, Kuldeep Ghosh, Anupama Raghuram

The University of Louisville Journal of Respiratory Infections

Streptococcus milleri group (SMG) also referred to as the Streptococcus anginosus group. These are Gram-positive, variable hemolysis, catalase negative, microaerophilic, non-motile facultative anaerobes which have been known to cause abscesses in humans. We report a case of empyema caused by Streptococcus anginosus in a patient with an unresolved pneumonia for over a month. In early October 2018, the patient presented to an emergency room with the complaints of shortness of air, productive cough, chills, subjective fever and weight loss for 4 weeks. A chest X-ray revealed a left lower lobe pneumonia. He was treated with 250 mg of azithromycin for …

H1n1 Influenza Virus (Swine Flu): A Comprehensive Insight Into Escalating Catch-22 Scenarios, Muhammad Shahzaib, Ehsan Ul Haq

The University of Louisville Journal of Respiratory Infections

Introduction: Viruses have always been a major cause of various disastrous pandemics in mankind’s history. H1N1 became a threat when its original strain was first discovered back in the swine flu pandemic of 2009. It became highly catastrophic on a large scale because none of the therapeutic interventions and methodologies that were already present at the time were effective against the virus.

Methods: A vast amount of literature and research is available regarding H1N1 influenza from different reputable sources online. The data were gathered with the contrasting and relative situations of 1918 and 2009 pandemics in mind. The overall extracted …

Epidemiology And Outcomes Of Hospitalized Adults With Sars-Cov-2 Community-Acquired Pneumonia In Louisville, Kentucky, Julio A. Ramirez, T'Shura Ali, Thomas Chandler, Stephen P. Furmanek, Daniya Sheikh, Vidyulata Salunkhe, Steven Gootee, Mohammad Tahboub, William A. Mattingly, Demetra Antimisiaris, Jiapeng Huang, Jose Bordon, Rodrigo Cavallazzi, Paul Schulz, William P. Mckinney, Dawn Balcom, Mark Burns, Ruth Carrico, Forest W. Arnold, Cerid Covid-19 Study Group

The University of Louisville Journal of Respiratory Infections

Background: During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV-2 community-acquired pneumonia (CAP) has been the primary cause of hospitalization. The objective of this study was to evaluate the clinical characteristics and outcomes of 1,013 patients hospitalized with SARS-CoV-2 CAP from September 2020 through March 2021 in Louisville, Kentucky.

Methods: This was a retrospective observational study of 1,013 patients hospitalized with SARS-CoV-2 CAP at eight of the adult hospitals in the city of Louisville from September 2020 through March 2021. Patients with 1) a positive reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, 2) fever, cough, or …

Antibiotics And Antimicrobial Resistance In The Covid-19 Era: Perspective From Resource-Limited Settings, Mentor Ali Ber Lucien, Michael F. Canarie, Paul E. Kilgore, Gladzin Jean-Denis, Natael Fénélon, Manise Pierre, Mauricio Cerpa, Gerard A. Joseph, Gina Maki, Marcus J. Zervos, Patrick Dely, Jacques Boncy, Hatim Sati, Ana Del Rio, Pilar Ramon-Pardo

Department of Pharmacy Practice

The dissemination of COVID-19 around the globe has been followed by an increased consumption of antibiotics. This is related to the concern for bacterial superinfection in COVID-19 patients. The identification of bacterial pathogens is challenging in low and middle income countries (LMIC), as there are no readily-available and cost-effective clinical or biological markers that can effectively discriminate between bacterial and viral infections. Fortunately, faced with the threat of COVID-19 spread, there has been a growing awareness of the importance of antimicrobial stewardship programs, as well as infection prevention and control measures that could help reduce the microbial load and hence …

Time Trends Of Overweight And Obesity Among Schoolchildren In Kuwait Over A 13-Year Period (2007-2019): Repeated Cross-Sectional Study, Abdullah Al-Taiar, Nawal Alqaoud, Ali H. Ziyab, Faheema Alanezi, Monica Subhakaran, Reem Sharaf Alddin, Hueiwang Anna Jeng, Muge Akpinar-Elci

Community & Environmental Health Faculty Publications

Objectives: This study aimed to examine age-specific trends in the prevalence of overweight and obesity in schoolchildren in Kuwait over a 13-year period (2007 to 2019) using the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and the International Obesity Taskforce (IOTF) definitions.

Design: Using cross-sectional approach, Kuwait Nutrition Surveillance System (KNSS) objectively measured weight and height of schoolchildren over a 13-year period. Log-binomial regression models were used to examine age-specific trends of obesity and overweight over the study period.

Setting: Public primary, middle, and high schools in all provinces of Kuwait.

Participants: Schoolchildren aged 5-19 …

Estimated Glomerular Filtration Rate And The Racial Multiplier: Clinical Implications And Current Attitudes, Brittney A. Spooner

Honors Theses and Capstones

Chronic kidney disease (CKD) is associated with high morbidity and mortality and has high and increasing incidence worldwide. CKD is characterized by a reduction in glomerular filtration rate (GFR), but as GFR is difficult to measure directly, estimated glomerular filtration rate (eGFR) equations have been created to measure serum creatinine levels as a function of GFR. Some eGFR equations contain a racial multiplier that increases the eGFR of black patients, causing a spurious increase in reported kidney function. This study included a literature search that collected information on the rationale behind the multipliers usage and a survey that gathered information …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Availability And Affordability Of Medicines And Cardiovascular Outcomes In 21 High-Income, Middle-Income And Low-Income Countries, Clara Kayei Chow, Tu Ngoc Nguyen, Simone Marschner, Rafael Diaz, Omar Rahman, Alvaro Avezum, Scott A. Lear, Koon Teo, Karen E. Yeates, Khawar Kazmi

Section of Cardiology

Objectives: We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.
Methods: We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types …

Gender And Racial Disparity For Hospital Emergency Service Usage In Usa: A Quantitative Analysis For Various Age Groups During 2010–2017., Subhendra N. Sarkar, Anthony F. Devito, Evans Lespinasse, Faisal Khosa

Publications and Research

Background: Annually emergency department (ED) services are utilized by more than 100 million Americans making ED usage trends important determinants of healthcare quality, outcomes and cost. Previous workers have demonstrated the existence of disparity in various healthcare services in USA although a comprehensive analysis has not been undertaken. Dahlgren and Whitehead rainbow model has offered insights for multiple factors of influence on an individual’s health and focuses on the relationships among these factors. The Commission on Social Determinants of Health (CSDH; WHO initiatives) suggests that the social and environmental factors are at the root of most of the inequalities responsible …

Looking Beyond A Rare Presentation Of Betel Nut Use In A North American Patient- An Opportunity For Lessons And Intervention In Global Health And Gender Equity, Muhammad O. Zaman, Thomas M. Park, Vikas Patel, Riley G. Jones

Journal of Refugee & Global Health

Betel nut is estimated to be the fourth most common psychoactive substance used globally behind caffeine, alcohol, and nicotine with 600 million global users. Betel nut use has a strong association with oral cancer and many other systemic effects including oral submucosal fibrosis. Although North American use is rare, its enduring effects may surface long after use posing a diagnostic challenge to practitioners caring for an increasingly global diaspora. Herein, we present a patient with severe trismus due to advanced oral submucosal fibrosis who was unexpectedly found to be importing and using Betel nut for over thirty years after immigrating. …

Gaining A “Foothold” On The Diagnosis Of Leishmaniasis, Brent M. Troy, Rebecca Hart, Navjyot Vidwan, Bethany Hodge

Journal of Refugee & Global Health

Pediatric refugees and immigrants may present with unusual diagnoses due to their extensive migration and potential harsh conditions in travel. Trauma and family separation add to the difficulty of obtaining a history of exposures. We report a case of one of the more commonly neglected tropical diseases, Leishmaniasis. A 15-year-old male refugee patient presented to the hospital with ulcerative lesions to his legs. His migration history was extensive, starting in Central Africa with travel to South America, followed by migration through Central America to Texas. The patient developed ulcerative lesions on his legs, and he was brought to the children’s …

Impact And Mortality Of Covid-19 On People Living With Dementia: Cross-Country Report, Aida Suárez-González, Gill Livingston, Lee Fay Low, Suzanne Cahill, Niamh Hennelly, Walter D. Dawson, Wendy Weidner, Martina Bocchetta, Cleusa P. Ferri, Jordi A. Matias-Guiu, Multiple Additional Authors

Institute on Aging Publications

This report brings together international evidence on the impact of the COVID-19 pandemic on people living with dementia and an overview of international policy and practice measures to mitigate the impact of COVID-19 among people living with dementia.

Key Findings

• We have collected data on impact and mortality of COVID-19 in people living with dementia in 9 countries: The United Kingdom (UK), Spain, Ireland, Italy, Australia, the United States (US), India, Kenya and Brazil.
• The share of people whose deaths were linked to COVID-19 in care homes who had dementia ranges from 29% to 75% across those countries. Within countries, …

A Comparison Efficacy Study Of Commercial Nasopharyngeal Swabs Versus A Novel 3d Printed Swab For The Detection Of Sars-Cov-2, Forest W. Arnold, Gerald Grant, Phillip F. Bressoud, Stephen P. Furmanek, Donghoon Chung, Nadine Sbaih, Dipan Karmali, Meredith Cahill, George Pantalos

The University of Louisville Journal of Respiratory Infections

Introduction: The large volume of diagnostic tests required by the response to the COVID-19 pandemic resulted in a shortage of commercial nasopharyngeal swabs. In an effort to alleviate the shortage, swabs created by 3D printing may be a solution.

Methods: We designed and produced 3D printed swabs and sought to compare their ability to detect SARS-CoV-2 in patients admitted for COVID-19 or who were suspected of having COVID-19.

Results: A total of 30 patients were swabbed with a commercial and a 3D printed swab. Results matched in 27 of 30 patients (90%). Two patients were discordant with a positive commercial …

How Immune T-Cell Augmentation Can Help Prevent Covid-19: A Possible Nutritional Solution Using Ketogenic Lifestyle, Ravi K. Kamepalli Md,Fidsa,Cwsp

The University of Louisville Journal of Respiratory Infections

No abstract provided.

484— Modeling Social Distancing Methods And Their Effectiveness In Combating The Spread Of Ebola, Rachel Fair

GREAT Day Posters

Ebola Virus Disease (EVD) is a rare but severe disease that is transmitted among humans through direct-contact with, and close proximity to, infected bodily fluids. From 2014-16, West Africa experienced the largest Ebola outbreak ever recorded, infecting over 28,000 people, and killing over 11,000. Although the symptoms of EVD are treatable, the disease can be extremely deadly, with an average of 50% EVD cases resulting in fatality. In areas where healthcare is scarce and vaccinations are not readily available, the practices of social distancing and self-quarantining have been shown to be highly effective in combating the spread of EVD. To …

Understanding Etiologies Of Road Traffic Crashes, Injuries, And Death For Patients At National Hospital Abuja: A Qualitative Content Analysis Using Haddon’S Matrix, Benjamin D. Holmes, Kristin Haglund, Emmanuel A. Ameh, Oluwole O. Olaomi, Uthman Uthman, Laura D. Cassidy

The Qualitative Report

Road traffic crashes and sequelae are reaching pandemic proportions globally and have currently achieved disproportionately high levels in Nigeria. Quantitative studies are accumulating in the peer-reviewed literature, but there is a paucity of qualitative research in Nigeria. Data for this study of structural and behavioral factors of road traffic crashes and injuries in Federal Capital Territory were collected in semi-structured interviews with crash survivors at National Hospital Abuja. Interviews were analyzed via qualitative content analysis, revealing crash location and participant beliefs about crash etiologies. Units of analysis were developed from participant statements and were structured within four a priori etiologic …

Older Adults Hospitalized For Pneumonia In The United States: Incidence, Epidemiology, And Outcomes., Forest W. Arnold, Andrea Reyes-Vega, Vidyulata Salunkhe, Stephen P. Furmanek, Christian Furman, Laura Morton, Anna Johan Faul, Pam Yankeelov, Julio A. Ramirez

Faculty and Staff Scholarship

OBJECTIVES: To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes. DESIGN: This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. SETTING: The study took place in all nine acute care hospitals for adults in Louisville, …

Mapping Misinformation In The Coronavirus Outbreak, Ana Santos Rutschman

All Faculty Scholarship

The coronavirus outbreak has sent ripples of fear and confusion across the world. These sentiments—and our collective responses to the outbreak—are made worse by rampant misinformation surrounding the new strain of the virus, COVID-2019. In this post, I survey some of the most pervasive areas of tentacular coronavirus-related misinformation that has proliferated online -- as well as the responses of social media companies like YouTube, Facebook, Pinterest and TikTok that may ultimately prove inadequate given the magnitude of the problem.

Plasma Cysteine/Cystine And Glutathione/Glutathione Disulfide Redox Potentials In Hiv And Copd Patients., Walter H. Watson, Jeffrey D. Ritzenthaler, Paula Peyrani, Timothy L. Wiemken, Stephen P. Furmanek, Andrea Reyes-Vega, Tom J. Burke, Yuxuan Zheng, Julio A. Ramirez, Jesse Roman

Faculty and Staff Scholarship

Chronic obstructive pulmonary disease (COPD) is prevalent in patients infected with HIV. The purpose of this study was to test the hypothesis that systemic oxidation correlates with loss of lung function in subjects with COPD, and that HIV infection can contribute to creating such an environment. Subjects were recruited at the University of Louisville in the following groups: HIV-infected (n = 36), COPD (n = 32), HIV and COPD (n = 28), and uninfected controls with normal lung function (n = 34). HIV infection was assessed by viral load and CD4 cell counts. Pulmonary function was determined by spirometry …

A Prospective, Population-Based Study Of Trends In Operative Vaginal Delivery Compared To Cesarean Delivery Rates In Low- And Middle-Income Countries, 2010-2016., Margo S. Harrison, Sarah Saleem, Sumera Ali, Omrana Pasha, Elwyn Chomba, Waldemar A. Carlo, Ana L. Garces, Nancy F. Krebs, K. Michael Hambidge, Shivaprasad S. Goudar, S. M. Dhaded, Bhala Kodkany, Richard J. Derman, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Edward A. Liechty, Antoinette Tshefu, Adrien Lokangaka, Melissa Bauserman, Carl L. Bose, Fernando Althabe, Jose M. Belizan, Pierre Buekens, Janet L. Moore, Dennis D. Wallace, Menachem Miodovnik, Marion Koso-Thomas, Elizabeth M. Mcclure, Robert L. Goldenberg

Global Health Articles

OBJECTIVE: Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time, across sites.

STUDY DESIGN: A prospective population-based study, including home and facility births among women enrolled from 2010 to 2016, was performed in communities in Argentina, Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Women were enrolled during pregnancy and delivery outcome data were collected.

RESULTS: We analyzed 354,287 …

Seeing Eye To Eye: A Machine Learning Approach To Automated Saccade Analysis, Maigh Attre

Honors Scholar Theses

Abnormal ocular motility is a common manifestation of many underlying pathologies particularly those that are neurological. Dynamics of saccades, when the eye rapidly changes its point of fixation, have been characterized for many neurological disorders including concussions, traumatic brain injuries (TBI), and Parkinson’s disease. However, widespread saccade analysis for diagnostic and research purposes requires the recognition of certain eye movement parameters. Key information such as velocity and duration must be determined from data based on a wide set of patients’ characteristics that may range in eye shapes and iris, hair and skin pigmentation [36]. Previous work on saccade analysis has …

Left Atrial Model, Borna Sobati, Sarah Porello, Tess Pate

Biomedical Engineering

The objective is to produce an electrophysiological model of an adult human left atrium. This model will be used to test mapping probe catheters used for locating cardiac arrhythmias against current technology used in practice. Dr. Chris Porterfield requested this model and other physicians or probe catheter manufacturers may also use this product in the future. Dr. Porterfield also discussed the possibility of future senior project groups using the model as a bench test for designing new catheter tips. The model will precisely simulate electrical behaviors of the heart in normal as well as arrhythmic conditions. Ideally, the model will …

Total And Free Plasma Bilirubin And Clinical Outcomes In Severe Hyperbilirubinemia, Sean M. Riordan, Jean-Baptiste Lepichon, Steven Shapiro, Tina Slusher, Fatima Abdullahi, Hafsat M. Suleiman, Victor C. Pam, Mamu B. Samuel, Christopher S. Yilgwan, Christian Isichei, Idris Y. Mohammed

Posters

Acute bilirubin encephalopathy (ABE) and kernicterus spectrum disorder (KSD) have become relatively uncommon in high income countries but remain a major cause of morbidity and mortality in low- and middle-income countries. To better understand the relationship between free (Bf) and total (TB) bilirubin levels and the development of ABE and KSD we followed infants born in three large tertiary centers in northern and central Nigeria (Jos, Kano and Zaria).

Developing Technologically Advanced Research In Low- And Middle-Income Countries, Isa Abdulkadir, Tina Slusher, Fidelia Bode-Thomas, Sean Riordan, Jean-Baptiste Lepichon, Laila Hassan, Shehu Abdullahi, Akinyemi Ofakunrin, Stephen Oguche, Steven Shapiro, William Ogala

Posters

This poster presents a collaboration between a group of scientists in Nigeria and the USA in developing a genomic research project and the solutions adopted in tackling the ethical implications and partnership equity and ownership of such a project.

3 Cm Researchers Honored With Endowed Chairs, Children's Mercy Hospital

Our Story Continues

Susan Abdel-Rahman, PharmD received the Marion Merrell Dow/Missouri Chair in Pediatric Clinical Pharmacology. Shao Jiang, MD received the Frederick J. McCoy Endowed Chair in Plastic Surgery and Craniofacial Research. Cy Nadler, PhD received the Josh Barnds and Stella Carlson Endowed Professorship for Autism.