Internal Medicine Commons^™

Is Antibiotic Prophylaxis Necessary After Endoscopic Ultrasound-Guided Fine-Needle Aspiration Of Pancreatic Cysts?, Seifeldin Hakim, Mihajlo Gjeorgjievski, Zubair Khan, Michael E Cannon, Kevin Yu, Prithvi Patil, Roy Tomas Davee, Sushovan Guha, Ricardo Badillo, Laith Jamil, Nirav Thosani, Srinivas Ramireddy

Faculty, Staff and Student Publications

BACKGROUND/AIMS: Current society guidelines recommend antibiotic prophylaxis for 3 to 5 days after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs). The overall quality of the evidence supporting this recommendation is low. In this study, we aimed to assess cyst infection and adverse event rates after EUS-FNA of PCLs among patients treated with or without postprocedural prophylactic antibiotics.

METHODS: We retrospectively reviewed all patients who underwent EUS-FNA of PCLs between 2015 and 2019 at two large-volume academic medical centers with different practice patterns of postprocedural antibiotic prophylaxis. Data on patient demographics, cyst characteristics, fine-needle aspiration technique, periprocedural and …

Association Of Atrial Septal Aneurysm And Shunt Size With Stroke Recurrence And Benefit From Patent Foramen Ovale Closure, Jean-Louis Mas, Jeffrey L Saver, Scott E Kasner, Jason Nelson, John D Carroll, Gilles Chatellier, Geneviève Derumeaux, Anthony J Furlan, Howard C Herrmann, Peter Jüni, Jong S Kim, Benjamin Koethe, Pil Hyung Lee, Benedicte Lefebvre, Heinrich P Mattle, Bernhard Meier, Mark Reisman, Richard W Smalling, Lars Sondergaard, Jae-Kwan Song, David E Thaler, David M Kent

Faculty, Staff and Student Publications

IMPORTANCE: The Patent Foramen Ovale (PFO)-Associated Stroke Causal Likelihood classification system combines information regarding noncardiac patient features (vascular risk factors, infarct topography) and PFO features (shunt size and presence of atrial septal aneurysm [ASA]) to classify patients into 3 validated categories of responsiveness to treatment with PFO closure. However, the distinctive associations of shunt size and ASA, alone and in combination, have not been completely delineated.

OBJECTIVE: To evaluate the association of PFO closure with stroke recurrence according to shunt size and/or the presence of an ASA.

DESIGN, SETTING, AND PARTICIPANTS: Pooled individual patient data from 6 randomized clinical trials …

Meaningful Improvement In General Health Outcomes With Guselkumab Treatment For Psoriatic Arthritis: Patient-Reported Outcomes Measurement Information System-29 Results From A Phase 3 Study, Ana-Maria Orbai, Laura C Coates, Atul Deodhar, Philip S Helliwell, Christopher T Ritchlin, Evan Leibowitz, Alexa P Kollmeier, Elizabeth C Hsia, Xie L Xu, Shihong Sheng, Yusang Jiang, Yan Liu, Chenglong Han

Faculty, Staff and Student Publications

OBJECTIVE: The Phase 3 DISCOVER-1 study of guselkumab is the first randomized controlled trial to use Patient-Reported Outcomes Measurement Information System (PROMIS) measures to assess the effects of treatment on general health outcomes in patients with psoriatic arthritis (PsA).

METHODS: Patients (N = 381) with active PsA were randomized 1:1:1 to guselkumab 100 mg every 4 weeks (Q4W); guselkumab 100 mg at Week 0, Week 4, then every 8 weeks (Q8W); or placebo with Week 24 crossover to guselkumab Q4W. The PROMIS-29 Profile contains four items for each of seven domains (anxiety, depression, fatigue, pain interference, physical function, sleep disturbance, …

Optical Molecular Imaging And Theranostics In Neurological Diseases Based On Aggregation-Induced Emission Luminogens, Peili Cen, Youyou Zhou, Chunyi Cui, Yen Wei, Zhen Cheng, Shuizhu Wu, Hong Zhang, Mei Tian

Faculty, Staff and Student Publications

Optical molecular imaging and image-guided theranostics benefit from special and specific imaging agents, for which aggregation-induced emission luminogens (AIEgens) have been regarded as good candidates in many biomedical applications. They display a large Stokes shift, high quantum yield, good biocompatibility, and resistance to photobleaching. Neurological diseases are becoming a substantial burden on individuals and society that affect over 50 million people worldwide. It is urgently needed to explore in more detail the brain structure and function, learn more about pathological processes of neurological diseases, and develop more efficient approaches for theranostics. Many AIEgens have been successfully designed, synthesized, and further …

Risk Factors For The Development Of Retinopathy In Prediabetes And Type 2 Diabetes: The Diabetes Prevention Program Experience, Neil H White, Qing Pan, William C Knowler, Emily B Schroeder, Dana Dabelea, Emily Y Chew, Barbara Blodi, Ronald B Goldberg, Xavier Pi-Sunyer, Christine Darwin, Mathias Schlögl, David M Nathan

Faculty, Staff and Student Publications

OBJECTIVE: To determine glycemic and nonglycemic risk factors that contribute to the presence of diabetic retinopathy (DR) before and after the onset of type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS: During the Diabetes Prevention Program (DPP) and DPP Outcome Study (DPPOS), we performed fundus photography over time in adults at high risk for developing T2D, including after they developed diabetes. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system, with DR defined as typical lesions of DR (microaneurysms, exudates, hemorrhage, or worse) in either eye.

RESULTS: By DPPOS year 16 (∼20 years after random …

Nab-Paclitaxel, Capecitabine, And Radiation Therapy After Induction Chemotherapy In Treating Patients With Locally Advanced And Borderline Resectable Pancreatic Cancer: Phase 1 Trial And Imaging-Based Biomarker Validation, Eugene J Koay, Mohamed Zaid, Maureen Aliru, Polycarpe Bagereka, Arie Van Wieren, Maria Jovie Rodriguez, Galia Jacobson, Robert A Wolff, Michael Overman, Gauri Varadhachary, Shubham Pant, Huamin Wang, Ching-Wei Tzeng, Naruhiko Ikoma, Michael Kim, Jeffrey E Lee, Matthew Hg Katz, Eric Tamm, Priya Bhosale, Cullen M Taniguchi, Emma B Holliday, Grace L Smith, Ethan B Ludmir, Bruce D Minsky, Christopher H Crane, Albert C Koong, Prajnan Das, Xuemei Wang, Milind Javle, Sunil Krishnan

Faculty, Staff and Student Publications

PURPOSE: Effective consolidative chemoradiation (CRT) regimens are lacking. In this phase 1 trial, we evaluated the safety and efficacy of nab-paclitaxel, capecitabine, and radiation therapy after induction chemotherapy in patients with locally advanced and borderline-resectable pancreatic cancer (LAPC and BRPC). Also, we evaluated a computed tomography (CT)-based biomarker of response.

METHODS AND MATERIALS: Eligible patients had pathologically confirmed pancreatic ductal adenocarcinoma, underwent computed tomography-imaging, received a diagnosis of LAPC or BRPC, and received induction chemotherapy. Standard 3 + 3 study design was used, with 3 escalating nab-paclitaxel dose levels (50, 75, and 100 mg/m

RESULTS: Twenty-three patients started and finished …

Medication Complexity Among Older Adults With Heart Failure – How Can We Assess Better?, Min Ji Kwak, Monica Cheng, Parag Goyal, Dae Hyun Kim, Scott L Hummel, Abhijeet Dhoble, Ashish Deshmukh, Rajender Aparasu, Holly M Holmes

Faculty, Staff and Student Publications

Medical management of heart failure (HF) has evolved and has achieved significant survival benefits, resulting in highly complex medication regimens. Complex medication regimens create challenges for older adults, including nonadherence and increased adverse drug events, especially associated with cognitive impairment, physical limitations, or lack of social support. However, the association between medication complexity and patients' health outcomes among older adults with HF is unclear. The purpose of this review is to address how the complexity of HF medications has been assessed in the literature and what clinical outcomes are associated with medication regimen complexity in HF. Further, we aimed to …

Assessment Of Bubble Activity Generated By Histotripsy Combined With Echogenic Liposomes, Aarushi Bhargava, Shaoling Huang, David D Mcpherson, Kenneth B Bader

Faculty, Staff and Student Publications

No abstract provided.

Naphthoquinones Oxidize H2s To Polysulfides And Thiosulfate, Implications For Therapeutic Applications, Kenneth R Olson, Kasey J Clear, Paul J Derry, Yan Gao, Zhilin Ma, Nathaniel M Cieplik, Alyssa Fiume, Dominic J Gaziano, Stephen M Kasko, Kathleen Narloch, Cecilia L Velander, Ifeyinwa Nwebube, Collin J Pallissery, Ella Pfaff, Brian P Villa, Thomas A Kent, Gang Wu, Karl D Straub

Faculty, Staff and Student Publications

1,4-Napththoquinones (NQs) are clinically relevant therapeutics that affect cell function through production of reactive oxygen species (ROS) and formation of adducts with regulatory protein thiols. Reactive sulfur species (RSS) are chemically and biologically similar to ROS and here we examine RSS production by NQ oxidation of hydrogen sulfide (H2S) using RSS-specific fluorophores, liquid chromatography-mass spectrometry, UV-Vis absorption spectrometry, oxygen-sensitive optodes, thiosulfate-specific nanoparticles, HPLC-monobromobimane derivatization, and ion chromatographic assays. We show that NQs, catalytically oxidize H2S to per- and polysulfides (H2Sn, n = 2−6), thiosulfate, sulfite and sulfate in reactions that consume oxygen and are accelerated by superoxide dismutase (SOD) and …

Unintended Consequences Of A Transition To Synchronous, Virtual Simulations For Interprofessional Learners, Tiffany Champagne-Langabeer, Samuel E Neher, Marylou Cardenas-Turanzas, Jennifer L Swails

Faculty, Staff and Student Publications

The coronavirus pandemic shifted in-person environments to virtual environments. Little is known about the effectiveness of fully synchronous, virtual interprofessional education (IPE). This study aims to compare two IPE cases that occurred in-person pre-pandemic and virtual during-pandemic. Two cases are analyzed: a medical error care and a charity care case. Participants were students from various health science disciplines. Assessments were captured through The Interprofessional Collaborative Competency Attainment Survey (ICCAS). Effect sizes were calculated for the pre-and post-surveys and analyzed using Cohen's d for independent samples. From the in-person collection period, a total of 479 students participated in the medical error …

Chemotherapy-Induced Toxicities And Their Associations With Clinical And Non-Clinical Factors Among Breast Cancer Patients In Vietnam, Sang M Nguyen, Anh T Pham, Lan M Nguyen, Hui Cai, Thuan V Tran, Xiao-Ou Shu, Huong T T Tran

Faculty, Staff and Student Publications

Understanding the burden and factors related to chemotherapy-induced toxicity is important in treatment planning for breast cancer patients. We conducted a prospective study among 396 newly diagnosed and chemotherapy-treated breast cancer patients recruited in two major cancer hospitals in northern Vietnam. Toxicities were captured through medical chart reviews and patient self-reports and graded using NCI CTCAE classification. Associations for sociodemographic and clinical factors with chemotherapy-induced toxicities during first-line chemotherapy were evaluated via multivariable logistic regression. Severe (i.e., grade ≥ 3) hematological (38.6%), and gastrointestinal (12.9%) toxicities were common. A pre-existing nephrological condition was significantly associated with the risk of severe …

Pathologic Predictors Of Response To Treatment Of Immune Checkpoint Inhibitor-Induced Kidney Injury, Ala Abudayyeh, Liye Suo, Heather Lin, Omar Mamlouk, Noha Abdel-Wahab, Amanda Tchakarov

Faculty, Staff and Student Publications

Background: Immune-related adverse events are a management challenge in patients receiving immune checkpoint inhibitors (ICIs). The most common renal immune-related adverse event, acute interstitial nephritis (AIN), is associated with patient morbidity and mortality. AIN, characterized by infiltration of renal tissue with immune cells, may be analogous to kidney transplant rejection. We evaluated clinical variables and pathologic findings to identify predictors of renal response and overall survival (OS) in patients with ICI-induced AIN. Design, setting, participants, and measurements: We reviewed the records and biopsy specimens of all 35 patients treated for ICI-induced AIN at our institution, between August 2007 and August …

Cannabidiol, ∆9 -Tetrahydrocannabinol, And Metabolites In Human Blood By Volumetric Absorptive Microsampling And Lc-Ms/Ms Following Controlled Administration In Epilepsy Patients, Federica Pigliasco, Sara Malaca, Alfredo Fabrizio Lo Faro, Anastasio Tini, Giuliana Cangemi, Alessia Cafaro, Sebastiano Barco, Antonella Riva, Angelica Pisati, Elisabetta Amadori, Pasquale Striano, Adriano Tagliabracci, Marilyn A. Huestis, Francesco Paolo Busardò

Institute of Emerging Health Professions Faculty Papers

Cannabidiol (CBD) exhibits anti-inflammatory, anxiolytic, antiseizure, and neuroprotective proprieties without addictive or psychotropic side effects, as opposed to Δ9-tetrahydrocannabinol (THC). While recreational cannabis contains higher THC and lower CBD concentrations, medical cannabis contains THC and CBD in different ratios, along with minor phytocannabinoids, terpenes, flavonoids and other chemicals. A volumetric absorptive microsampling (VAMS) method combined with ultra-high-performance liquid chromatography coupled with mass spectrometry in tandem for quantification of CBD, THC and their respective metabolites: cannabidiol-7-oic acid (7-COOH-CBD); 7-hydroxy-cannabidiol (7-OH-CBD); 6-alpha-hydroxy-cannabidiol (6-α-OH-CBD); and 6-beta-hydroxycannabidiol (6-β-OH-CBD); 11- Hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) and 11-Nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH). After overnight enzymatic glucuronide hydrolysis at 37°C, samples underwent acidic …

Giant Gastric Polyp Mimicking A Duodenal Tumor, Ioana Duca, Florin Mihaileanu, Alexandra Chira, Romeo Chira, Teodora Surdea Blaga, Diana Popovici, Adriana Albu, Dan Lucian Dumitrascu

Journal of Mind and Medical Sciences

Inflammatory fibroid polyps are very rare gastrointestinal tumors. We present the case of a 66-year-old woman with severe anemia and a giant gastric polyp which had intermittent duodenal intussusception. Ultrasonography showed increased gastric wall thickness and suspected an ampulloma, as revealed also by endoscopy and computed tomography. Ultrasonography reassessment showed later the intragastric mass, which was confirmed by endosonography: giant pediculated hypervascular polyp suggesting malignancy. Challenging phenomena at different investigation methods were due to intermittent protrusion into the first duodenal segment mimicking an ampulloma, but without gastric outlet syndrome or a malignant component, despite the severe anemia. Abnormal US aspect …

Clinical And Biological Factors With Prognostic Value In Acute Pancreatitis, Mihai Faur, Dan Dumitrescu, Dan Sabau, Ciprian Tanasescu, Dan Cretu, Denisa Tanasescu, Vlad Denis Constantin, Calin Mohor

Journal of Mind and Medical Sciences

Acute pancreatitis is an acute inflammatory process of the pancreas, which can remain localized at the level of the gland or can extend to the peripancreatic and retroperitoneal tissues. The use and interpretation of paraclinical examinations at the onset can predict the form of evolution of acute pancreatitis (mild or severe). Depending on the evolution, these data are useful in determining the type of surgical intervention that might be necessary based on severity.

We present a retrospective study consisting of 118 patients diagnosed and hospitalized with acute pancreatitis during 2016-2020 in the Surgery I section of the Sibiu County Emergency …

Eating Disorders In Men: A Comprehensive Summary, Connor James Spratt, Liam Alexander Mackenzie Myles, Emanuele Maria Merlo

Journal of Mind and Medical Sciences

Eating disorders (EDs) have detrimental effects on an individual’s physical and mental health, along with significant interpersonal, social and economic effects. Furthermore, men who are suffering with an ED face unique challenges with this. Men suffering with EDs have historically received little attention within ED research, diagnosis and intervention. However, the number of men suffering with these issues is significant and growing. Understanding of EDs tend to ignore male experiences, meaning many are left to suffer in silence until the ED has developed to a critical point. However, many now recognize the need to understand the issues facing men suffering …

Prevalence Of Prediabetes And Diabetes Vary By Ethnicity Among Us Asian Adults At Healthy Weight, Overweight, And Obesity Ranges: An Electronic Health Record Study, William S Vicks, Joan C Lo, Lynn Guo, Jamal S Rana, Sherry Zhang, Nirmala D Ramalingam, Nancy P Gordon

Faculty, Staff and Student Publications

BACKGROUND: Asian adults develop Type 2 diabetes at a lower body mass index (BMI) compared to other racial/ethnic groups. We examined the variation in prevalence of prediabetes and diabetes among Asian ethnic groups within weight strata by comparing middle-aged Chinese, Filipino, South Asian, and White adults receiving care in the same integrated healthcare delivery system.

METHODS: Our retrospective cross-sectional U.S. study examined data from 283,110 (non-Hispanic) White, 33,263 Chinese, 38,766 Filipino, and 17,959 South Asian adults aged 45-64 years who were members of a Northern California health plan in 2016 and had measured height and weight. Prediabetes and diabetes were …

Loss Of Activity-Induced Mitochondrial Atp Production Underlies The Synaptic Defects In A Drosophila Model Of Als, Nicholas E Karagas, Richa Gupta, Elham Rastegari, Kai Li Tan, Ho Hang Leung, Hugo J Bellen, Kartik Venkatachalam, Ching-On Wong

Faculty, Staff and Students Publications

Mutations in the gene encoding vesicle-associated membrane protein B (VAPB) cause a familial form of amyotrophic lateral sclerosis (ALS). Expression of an ALS-related variant of vapb (vapb^P58S) in Drosophila motor neurons results in morphologic changes at the larval neuromuscular junction (NMJ) characterized by the appearance of fewer, but larger, presynaptic boutons. Although diminished microtubule stability is known to underlie these morphologic changes, a mechanism for the loss of presynaptic microtubules has been lacking. By studying flies of both sexes, we demonstrate the suppression of vapb^P58S-induced changes in NMJ morphology by either a loss of endoplasmic …

A Qualitative Study Of Preclinical Medical Students Randomized To Patient-Partnered Vs Traditional Clinical Experiences, Joyce W. Tang, Tia Kostas, Anshu Verma, Valerie G. Press, Josef Kushner, Nicole Gier, Lauren O. Wiklund, Vineet M. Arora, Jeanne Farnan, David O. Meltzer

Journal of Patient-Centered Research and Reviews

Purpose: Longitudinal patient-partnered experiences may promote medical student empathy, but evaluation of such programs is limited. The aim of this study was to compare areas of learning among first-year medical students randomized to a patient-centered track (PCT) or traditional track (TT) longitudinal clinical experience.

Methods: PCT students (n = 24) were paired with 2 patients and a physician to participate in their patients’ care across multiple settings. TT students (n = 56) were paired with a physician preceptor and participated in caring for a variety of patients in a single setting. This qualitative study used a phenomenological approach to template …

Patient Perspectives On Opioid Risk Discussions In Primary Care, Stephanie A. Hooker, Inih J. Essien, Caitlin M. Borgert-Spaniol, Rebecca C. Rossom, Anthony W. Olson, Katrina M. Romagnoli, Leif I. Solberg

Journal of Patient-Centered Research and Reviews

Purpose: Both patients and clinicians have described discussions of potential opioid risks as challenging. This study’s goal was to understand patient perspectives on discussing opioid risks with primary care clinicians (PCCs).

Methods: Patients identified to be at elevated risk for problems with opioids (ie, opioid use disorder [OUD] diagnosis, taking a medication for OUD, or having ≥ 3 opioid prescriptions in the last year) were recruited from an integrated, Upper Midwest health system to participate in semi-structured qualitative interviews. Interview questions aimed to better understand patient views on conversations about opioid risks with PCCs and perceptions of OUD screening and …