Internal Medicine Commons^™

Hemiplegic Migraines; A Barrage On The Mind, Ganesh Arun, Omar Siddiqui, Ellen Sampson, Adnaan Sheikh, Harsha Surath, Dayakar Reddy

Advances in Clinical Medical Research and Healthcare Delivery

Hemiplegic migraines (HM) are a rare type of migraine with an aura phase that includes muscle weakness. This form of migraine can either occur sporadically or can be seen in patients with familial hemiplegic migraine which is an autosomal dominant subtype that runs in families. Migraines are classically accompanied by phonophobia, photophobia, neurological symptoms, nausea or vomiting. The subcategory of hemiplegic migraine involves a transient wave of motor weakness and muscle spasms secondary to decreased threshold of excitation in the neurologic system. The etiology of Hemiplegic Migraines is either idiopathic condition or genetic mutation in the CACNA1A, ATP1A2 and SCN1A …

Physician And Patient Moves In The Hospital Do Not Move Patient Satisfaction: A Single-Center Retrospective Analysis, Basil George Verghese, Nagesh Jadhav, Walter A. Polashenski, Carl H. Reynolds

Advances in Clinical Medical Research and Healthcare Delivery

Background. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey for measuring patient's experiences at US hospitals. There is a shift towards geographically assigning patients and physicians. However, its impact on patient satisfaction scores has not been studied.

Objective: Examine the correlation between patient experience and overall hospital rating with the number of physicians seen and the number of times the patient was moved during a hospitalization.

Methods: A retrospective observational study was performed using select HCAHPS & Press Ganey survey questions to assess physician satisfaction scores and overall hospital rating and recommendation scores.

Results: There …

A Cluster Randomized Controlled Trial For A Multi-Level, Clinic-Based Smoking Cessation Program With Women In Appalachian Communities: Study Protocol For The "Break Free" Program, Joanne G. Patterson, Tia N. Borger, Jessica L. Burris, Mark Conaway, Robert Klesges, Amie Ashcraft, Lindsay Hauser, Connie Clark, Lauren Wright, Sarah Cooper, Merry C. Smith, Mark B. Dignan, Stephenie Kennedy-Rea, Electra D. Paskett, Roger Anderson, Amy K. Ferketich

Psychology Faculty Publications

BACKGROUND: The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program.

METHODS: The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote …

Implementation Of A Drive-Through Covid-19 Mass Vaccination Site: Experiences From Louvax–Broadbent In Louisville, Kentucky, Ruth Carrico, Sarah Beth Hartlage, Valenchia Brown Msn, Aprn, Fnp-C, Sarah M. Bishop, Luanne Didelot, William Hayden, Beverly Williams Coleman, Sarah Tan, Delanor Manson, Kellie Kane, Dawn Balcom, Paul Kern

The University of Louisville Journal of Respiratory Infections

Background: Response to the COVID-19 pandemic has required innovative approaches to vaccination, including methods to rapidly and safely immunize communities. A major challenge to such a response involved access to untapped healthcare worker resources. The Louisville, Kentucky, response involved the use of a large volunteer workforce to supplement local public health employees in planning and implementing a large-scale drive-through vaccination event. The objective of this manuscript was to outline processes involved in training a mass immunization workforce and implementating a large-scale COVID-19 community vaccination.

Approach: Competency-based and standardized training was provided for every volunteer before working their shift. Volunteers worked …

Catheter-Associated Urinary Tract Infections: Patient Characteristics, Treatment, And Clinical Outcomes In One South Texas Acute Care Hospital, Kimberly A. Ambrosini, Jose Campo Maldonado

MEDI 9331 Scholarly Activities Clinical Years

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital.

Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes.

Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients …

Baseline Blood Count Levels Increase Odds Of Cytopenia Among Cml Patients In Kenya: A Case Control Study, Angela Mcligeyo, Jamilla Rajab, Peter Oyiro, Mohammed Ezzi, Yatich Bett, Matilda Ong’Ondi, Andrew Odhiambo, Sitna Mwanzi, Nicholas Othieno-Abinya

Internal Medicine, East Africa

Background: Imatinib is the gold standard for the treatment of all phases of Philadelphia positive Chronic Myeloid Leukemia (CML). During treatment, patients may develop cytopenia. We aimed to study the baseline characteristics and factors associated with cytopenia at a Nairobi Hospital.

Methods: This was a retrospective case-control study of patients aged ≥18 years on follow-up at the Glivec Inter‑ national Patient Access Program (GIPAP) clinic from 2007 to 2015. The cases consisted of CML patients on imatinib who developed cytopenia. The controls were CML patients on imatinib who did not develop cytopenia. Baseline socio – demographic, clinical, hematologic, …

Frequency And Types Of Healthcare Encounters In The Week Preceding A Sepsis Hospitalization: A Systematic Review, Alexander H. Flannery, Chad M. Venn, Amanda Gusovsky, Stephanie Henderson, Adam S. Kiser, Hallie C. Prescott, Chanu Rhee, Chris Delcher, Peter E. Morris

Pharmacy Practice and Science Faculty Publications

OBJECTIVES: Early recognition and treatment are critical to improving sepsis outcomes. We sought to identify the frequency and types of encounters that patients have with the healthcare system in the week prior to a sepsis hospitalization.

DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and the Cochrane Library.

STUDY SELECTION: Observational cohort studies of patients hospitalized with sepsis or septic shock that were assessed for an outpatient or emergency department encounter with the healthcare system in the week prior to hospital admission.

DATA EXTRACTION: The primary outcome was the proportion of patients with a healthcare encounter …

Artificial Intelligence In Clinical And Translational Science: Successes, Challenges And Opportunities, Elmer V Bernstam, Paula K Shireman, Funda Meric-Bernstam, Meredith N Zozus, Xiaoqian Jiang, Bradley B Brimhall, Ashley K Windham, Susanne Schmidt, Shyam Visweswaran, Ye Ye, Heath Goodrum, Yaobin Ling, Seemran Barapatre, Michael J Becich

Faculty, Staff and Student Publications

Artificial intelligence (AI) is transforming many domains, including finance, agriculture, defense, and biomedicine. In this paper, we focus on the role of AI in clinical and translational research (CTR), including preclinical research (T1), clinical research (T2), clinical implementation (T3), and public (or population) health (T4). Given the rapid evolution of AI in CTR, we present three complementary perspectives: (1) scoping literature review, (2) survey, and (3) analysis of federally funded projects. For each CTR phase, we addressed challenges, successes, failures, and opportunities for AI. We surveyed Clinical and Translational Science Award (CTSA) hubs regarding AI projects at their institutions. Nineteen …

Efficacy And Safety Of Covid-19 Convalescent Plasma In Hospitalized Patients: A Randomized Clinical Trial, Mila B Ortigoza, Hyunah Yoon, Keith S Goldfeld, Andrea B Troxel, Johanna P Daily, Yinxiang Wu, Yi Li, Danni Wu, Gia F Cobb, Gillian Baptiste, Mary O'Keeffe, Marilou O Corpuz, Luis Ostrosky-Zeichner, Amee Amin, Ioannis M Zacharioudakis, Dushyantha T Jayaweera, Yanyun Wu, Julie V Philley, Megan S Devine, Mahalia S Desruisseaux, Alessandro D Santin, Shweta Anjan, Reeba Mathew, Bela Patel, Masayuki Nigo, Rabi Upadhyay, Tania Kupferman, Andrew N Dentino, Rahul Nanchal, Christian A Merlo, David N Hager, Kartik Chandran, Jonathan R Lai, Johanna Rivera, Chowdhury R Bikash, Gorka Lasso, Timothy P Hilbert, Monika Paroder, Andrea A Asencio, Mengling Liu, Eva Petkova, Alexander Bragat, Reza Shaker, David D Mcpherson, Ralph L Sacco, Marla J Keller, Corita R Grudzen, Judith S Hochman, Liise-Anne Pirofski, Lalitha Parameswaran, Anthony T Corcoran, Abhinav Rohatgi, Marta W Wronska, Xinyuan Wu, Ranjini Srinivasan, Fang-Ming Deng, Thomas D Filardo, Jay Pendse, Simone B Blaser, Olga Whyte, Jacqueline M Gallagher, Ololade E Thomas, Danibel Ramos, Caroline L Sturm-Reganato, Charlotte C Fong, Ivy M Daus, Arianne Gisselle Payoen, Joseph T Chiofolo, Mark T Friedman, Ding Wen Wu, Jessica L Jacobson, Jeffrey G Schneider, Uzma N Sarwar, Henry E Wang, Ryan M Huebinger, Goutham Dronavalli, Yu Bai, Carolyn Z Grimes, Karen W Eldin, Virginia E Umana, Jessica G Martin, Timothy R Heath, Fatimah O Bello, Daru Lane Ransford, Maudry Laurent-Rolle, Sheela V Shenoi, Oscar Bate Akide-Ndunge, Bipin Thapa, Jennifer L Peterson, Kelly Knauf, Shivani U Patel, Laura L Cheney, Christopher A Tormey, Jeanne E Hendrickson

Faculty, Staff and Student Publications

IMPORTANCE: There is clinical equipoise for COVID-19 convalescent plasma (CCP) use in patients hospitalized with COVID-19.

OBJECTIVE: To determine the safety and efficacy of CCP compared with placebo in hospitalized patients with COVID-19 receiving noninvasive supplemental oxygen.

DESIGN, SETTING, AND PARTICIPANTS: CONTAIN COVID-19, a randomized, double-blind, placebo-controlled trial of CCP in hospitalized adults with COVID-19, was conducted at 21 US hospitals from April 17, 2020, to March 15, 2021. The trial enrolled 941 participants who were hospitalized for 3 or less days or presented 7 or less days after symptom onset and required noninvasive oxygen supplementation.

INTERVENTIONS: A unit of …

Improving Transcatheter Aortic Valve Interventional Predictability Via Fluid-Structure Interaction Modelling Using Patient-Specific Anatomy, Vijay Govindarajan, Arun Kolanjiyil, Nils P Johnson, Hyunggun Kim, Krishnan B Chandran, David D Mcpherson

Faculty, Staff and Student Publications

Transcatheter aortic valve replacement (TAVR) is now a standard treatment for high-surgical-risk patients with severe aortic valve stenosis. TAVR is being explored for broader indications including degenerated bioprosthetic valves, bicuspid valves and for aortic valve (AV) insufficiency. It is, however, challenging to predict whether the chosen valve size, design or its orientation would produce the most-optimal haemodynamics in the patient. Here, we present a novel patient-specific evaluation framework to realistically predict the patient's AV performance with a high-fidelity fluid-structure interaction analysis that included the patient's left ventricle and ascending aorta (AAo). We retrospectively evaluated the pre- and post-TAVR dynamics of …

Conceptual Framework For A Cardiac Surgery Simulation Laboratory And Competency-Based Curriculum In Pakistan - A Short Innovation Report, Ali Aahil Noorali, Asma A H. Merchant, Sardar Shahmir Babar Chauhan, Mustafa Ali Khan, Anam Noor Ehsan, Mohammad Bin Pervez, Muhammad Tariq, Saulat Fatimi

Medical College Documents

Simulation is a commonly utilized technique in healthcare education as it provides trainees a realistic, but safe, environment to learn a variety of skills. Trainees belonging to fields known for high stakes with low margins for error, such as cardiac surgery, can greatly benefit from simulation-based education. We propose the establishment of the first multi-tier high fidelity cardiac surgery simulation lab with a structured curriculum that will eventually provide multidisciplinary training to promising cardiac surgeons across Pakistan. The simulation lab may also be used for research, grant acquisition and patent development. Our setup will include the following levels of simulation: …

Comparative Performance Of Risk Prediction Models For Hepatitis B-Related Hepatocellular Carcinoma In The United States, Hyun-Seok Kim, Xian Yu, Jennifer Kramer, Aaron P Thrift, Pete Richardson, Yao-Chun Hsu, Avegail Flores, Hashem B El-Serag, Fasiha Kanwal

Faculty, Staff and Students Publications

BACKGROUND & AIMS: Guidelines recommend hepatocellular carcinoma (HCC) surveillance in patients with chronic HBV infection. Several HCC risk prediction models are available to guide surveillance decisions, but their comparative performance remains unclear.

METHODS: Using a retrospective cohort of patients with HBV treated with nucleos(t)ide analogues at 130 Veterans Administration facilities between 9/1/2008 and 12/31/2018, we calculated risk scores from 10 HCC risk prediction models (REACH-B, PAGE-B, m-PAGE-B, CU-HCC, HCC-RESCUE, CAMD, APA-B, REAL-B, AASL-HCC, RWS-HCC). We estimated the models' discrimination and calibration. We calculated HCC incidence in risk categories defined by the reported cut-offs for all models.

RESULTS: Of 3,101 patients …

(#Womeninddw) Persistent Speaker Gender Gap At The Premier Digestive Disease Event, Zubair Khan, Rabia Rukhshan, Asmeen Bhatt, Sushovan Guha, Srinivas Ramireddy, Prithvi Patil, Ricardo Badillo, Roy Tomas Davee, Nirav Thosani

Faculty, Staff and Student Publications

BACKGROUND: Over the last few decades, advances have been made regarding gender equality starting from medical students to trainees, to leadership in academics. The female representation in specialty academic conferences not only reflects the existing gender disparities in that specialty but also can influence young female trainees to join that field. Digestive Disease Week (DDW) is the premier digestive disease event. We aimed to calculate the proportion of female representation among speakers and moderators at the DDW meetings held from 2018 to 2020.

METHODS: The data for DDW 2018-2020 were collected via the online web-based planner. The gender of speakers …

Gut Microbial Trimethylamine Is Elevated In Alcohol-Associated Hepatitis And Contributes To Ethanol-Induced Liver Injury In Mice, Robert N. Helsley, Tatsunori Miyata, Anagha Kadam, Venkateshwari Varadharajan, Naseer Sangwan, Emily C. Huang, Rakhee Banerjee, Amanda L. Brown, Kevin K. Fung, William J. Massey, Chase Neumann, Danny Orabi, Lucas J. Osborn, Rebecca C. Schugar, Megan R. Mcmullen, Annette Bellar, Kyle L. Poulsen, Adam Kim, Vai Pathak, Marko Mrdjen

Pediatrics Faculty Publications

There is mounting evidence that microbes residing in the human intestine contribute to diverse alcohol-associated liver diseases (ALD) including the most deadly form known as alcohol-associated hepatitis (AH). However, mechanisms by which gut microbes synergize with excessive alcohol intake to promote liver injury are poorly understood. Furthermore, whether drugs that selectively target gut microbial metabolism can improve ALD has never been tested. We used liquid chromatography tandem mass spectrometry to quantify the levels of microbe and host choline co-metabolites in healthy controls and AH patients, finding elevated levels of the microbial metabolite trimethylamine (TMA) in AH. In subsequent studies, we …

Quantitative Estimation Of Protein In Sprouts Of Vigna Radiate (Mung Beans), Lens Culinaris (Lentils), And Cicer Arietinum (Chickpeas) By Kjeldahl And Lowry Methods, Nayab Batool Rizvi, Samina Aleem, Mohammad Rizwan Khan, Sadia Ashraf, Rosa Busquets

Faculty, Staff and Student Publications

Protein scarcity is the most vital cause of long-lasting diseases and even untimely deaths in some developing nations. The application of protein in food is advantageous from the point of view of non-toxicity, biocompatibility, and dietary benefits. This study aimed to determine the protein contents of the sprouts of

Prevalence Of Infectious Diseases Among 6078 Individuals With Down Syndrome In The United States, Veronica Fitzpatrick, Anne Rivelli, Sagar Chaudhari, Laura Chicoine, Gengjie Jia, Andrey Rzhetsky, Brian Chicoine

Journal of Patient-Centered Research and Reviews

A recent disease prevalence study of the largest documented Down syndrome (DS) cohort in the United States strongly suggested significant disparity in general infectious disease conditions among individuals with DS versus those without DS. In this follow-up retrospective analysis, we explored these differences in greater detail by calculating prevalence of 52 infectious diseases, across 28 years of data among 6078 individuals with DS and 30,326 age- and sex-matched controls, abstracted from electronic medical records within a large Midwestern health system. We found that the DS cohort had higher prevalence of pneumonias (including aspiration, viral, bacterial, pneumococcal, and unspecified/atypical); otitis externa; …

Prevalence Of Endocrine Disorders Among 6078 Individuals With Down Syndrome In The United States, Anne Rivelli, Veronica Fitzpatrick, Danielle Wales, Laura Chicoine, Gengjie Jia, Andrey Rzhetsky, Brian Chicoine

Journal of Patient-Centered Research and Reviews

Findings from a recent study describing prevalence of common disease conditions in the largest documented cohort of individuals with Down syndrome (DS) in the United States strongly suggested significant disparity in endocrine disorders among these individuals when compared with age- and sex-matched individuals without DS. This retrospective, descriptive study is a follow-up report documenting prevalence of 21 endocrine disorder conditions, across 28 years of data, from 6078 individuals with DS and 30,326 age- and sex-matched controls, abstracted from electronic medical records within a large integrated health system. Overall, individuals with DS experienced higher prevalence of adrenal insufficiency and Addison’s disease; …

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 …

Cystic Fibrosis And Sleep Circadian Rhythms, Mariam Louis, Peter Staiano, Lavender Micalo, Nauman Chaudary

Internal Medicine Publications

Cystic fibrosis (CF) is due to a mutation in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which leads to unusual water and chloride secretion across epithelial surfaces. The lungs are responsible for most morbidity, though other organs are frequently affected. Sleep abnormalities have long been recognized in CF. Abnormal ventilation and oxygenation, sinus disease, deconditioning due to muscle weakness and recurrent infections, and inflammation have been thought to play a role in sleep disorders in CF. However, there is evidence that CFTR gene dysregulation can affect circadian rhythms in CF. Early recognition and treatment of circadian rhythms may improve …

Effect Of Interleukin-1 Blockade With Anakinra On Leukocyte Count In Patients With St-Segment Elevation Acute Myocardial Infarction, Marco Giuseppe Del Buono, Juan I. Damonte, Cory R. Trankle, Dinesh Kadariya, Salvatore Carbone, Georgia Thomas, Jeremy Turlington, Roshanak Markley, Justin M. Canada, Giuseppe G. Biondi‐Zoccai, Michael C. Kontos, Benjamin W. Van Tassell, Antonio Abbate

Internal Medicine Publications

Leukocytosis is a common finding in patients with ST elevation myocardial infarction (STEMI) and portends a poor prognosis. Interleukin 1-β regulates leukopoiesis and pre-clinical studies suggest that anakinra (recombinant human interleukin-1 [IL-1] receptor antagonist) suppresses leukocytosis in myocardial infarction. However, the effect of IL-1 blockade with anakinra on leukocyte count in patients with STEMI is unknown. We reviewed the white blood cell (WBC) and differential count of 99 patients enrolled in a clinical trial of anakinra (n = 64) versus placebo (n = 35) for 14 days after STEMI. A complete blood cell count with differential count were obtained at …