Internal Medicine Commons^™

Optimizing Delirium Care In The Era Of Age-Friendly Health System, Min Ji Kwak, Sharon K Inouye, Donna M Fick, Alice Bonner, Terry Fulmer, Emily Carter, Victor Tabbush, Kerri Maya, Nicholas Reed, Christine Waszynski, Esther S Oh

Faculty, Staff and Student Publications

Delirium is a significant geriatric condition associated with adverse clinical and economic outcomes. The cause of delirium is usually multifactorial, and person-centered multicomponent approaches for proper delirium management are required. In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) launched a national initiative, Age-Friendly Health System (AFHS), promoting the use of a framework called 4Ms (what matters, medication, mentation, and mobility). The 4Ms framework's primary goal is to provide comprehensive and practical person-centered care for older adults and it aligns with the core concepts of optimal delirium management. In this special article, we demonstrate how …

Victory Out Of Tragedy: Organ Donation, Ali Salim, Bryan A Cotton

Faculty, Staff and Student Publications

Major improvements in trauma care during the last decade have improved survival rates in the severely injured. The unintended consequence is the presentation of patients with non-survivable injuries in a time frame in which intervention is considered and often employed due to prognostic uncertainty. In light of this, discerning survivability in these patients remains increasingly problematic. Evidence-based cut-points of futility can guide early decisions for discontinuing aggressive treatment and use of precious resources in severely injured patients arriving in extremis.

Facing Futility In Hemorrhagic Shock: When To Say ‘When’ In Children And Adults, Bryan A Cotton

Faculty, Staff and Student Publications

No abstract provided.

Postsurgical Pyoderma Gangrenosum After Penile Inversion Vaginoplasty: Case With Review Of Diagnostic And Management Strategies, Michael M Talanker, Jessica R Nye, David T Mitchell, Daniel J Freet

Faculty, Staff and Student Publications

BACKGROUND: Postsurgical pyoderma gangrenosum (PSPG) is a highly uncommon and unpredictable wound healing complication. Rapid progression of ulcers at incisions can cause unfettered dehiscence. Most commonly, PSPG involves breast procedures; however, in this work, we detail a case of a patient who developed PSPG 10 days postoperatively after penile inversion vaginoplasty.

METHODS: The patient in this case underwent a penile inversion vaginoplasty with orchiectomy in the standard fashion. She had no risk factors for PSPG. Following an uncomplicated hospital stay, the patient developed difficulty with pain control and increasing serous drainage on the 10th postoperative day. On readmission, the patient …

Outcomes Of Upper Gastrointestinal Bleeding In Hospitalized Covid-19 Patients In The United States: A Propensity-Score Matched Analysis Of A Large National Database, Moon Ryu, Mohammed Quazi, Niloy Ghosh, Karthik Gangu, Amir H Sohail, Asif Farooq, Babu S Maringanti, Aman Goyal, Anupa Patel, Muhammad S Khan, Abu B Sheikh

Faculty, Staff and Student Publications

Patients with cirrhosis that are hospitalized with COVID-19 infection have been found to have worse outcomes. No comparative study has been conducted between gastrointestinal (GI) bleeding in patients with cirrhosis who are diagnosed with COVID-19. We utilized the National Inpatient Sample (NIS) database to perform a retrospective analysis of 24, 050 patients diagnosed with cirrhosis and COVID-19. The identified patients were separated into variceal bleeding, nonvariceal bleeding, and no (or neither) GI bleeding groups. After performing propensity sample matching and multivariate analysis of mortality, we found no significant differences in mortality among the three groups. However, the variceal bleed group …

Anticancer Effects Of Wild Baicalin On Hepatocellular Carcinoma: Downregulation Of Akr1b10 And Pi3k/Akt Signaling Pathways, Longjun Sun, Wenjuan Chen, Peixi Zhao, Bin Zhao, Guangyan Lei, Le Han, Yili Zhang

Faculty, Staff and Student Publications

ntroduction

Hepatocellular carcinoma (HCC) is a common and deadly malignancy. Traditional Chinese medicine, such as the compound Astragalus (wild Baicalin), has shown promise in improving outcomes for HCC patients. This study aimed to investigate the effects of wild Baicalin on the human hepatoma cell line HepG2 and elucidate the underlying mechanisms, particularly the role of the AKR1B10 and PI3K/AKT signaling pathways.

Methods

HepG2 cells were treated with varying concentrations of wild Baicalin. Cell proliferation, apoptosis, migration, invasion, and cell cycle were evaluated using CCK-8, flow cytometry, scratch, Transwell, and clonogenic assays, respectively. Transcriptome sequencing was performed to analyze gene expression …

Simultaneous Submission Of Seven Ctsa Proposals: Um1, K12, R25, T32-Predoctoral, T32-Postdoctoral, And Rc2: Strategies, Evaluation, And Lessons Learned, Carolina Lema, Kwai Wa Cheng, Delanderia M Anderson, Charles C Miller, Daniel D Karp, David D Mcpherson, Satya Sree N Kolar

Faculty, Staff and Student Publications

Translation is the process of turning observations in the research laboratory, clinic, and community into interventions that improve people's health. The Clinical and Translational Science Awards (CTSA) program is a National Center for Advancing Translational Sciences (NCATS) initiative to advance translational science and research. Currently, 64 "CTSA hubs" exist across the nation. Since 2006, the Houston-based Center for Clinical Translational Sciences (CCTS) has assembled a well-integrated, high-impact hub in Texas that includes six partner institutions within the state, encompassing ∼23,000 sq. miles and over 16 million residents. To achieve the NCATS goal of "more treatments for all people more quickly," …

Demographic Disparities In Incidence And Mortality Rates Of Current Dengue Outbreak In Bangladesh, Sadia Ashraf, Muhammad Mainuddin Patwary, Alfonso J Rodriguez-Morales

Faculty, Staff and Student Publications

No abstract provided.

Exposure To Urban Green Spaces And Mental Health During The Covid-19 Pandemic: Evidence From Two Low And Lower-Middle-Income Countries, Muhammad Mainuddin Patwary, Mondira Bardhan, Hüseyin Ertan İnan, Matthew H E M Browning, Asma Safia Disha, Md Zahidul Haque, Mai Helmy, Sadia Ashraf, Angel M Dzhambov, Faysal Kabir Shuvo, Md Ashraful Alam, Sharif Mutasim Billah, Md Pervez Kabir, Md Riad Hossain, Md Golam Azam, Md Mijanur Rahman, Sarya Swed, Ranjit Sah, Juan J Montenegro-Idrogo, D Katterine Bonilla-Aldana, Alfonso J Rodriguez-Morales

Faculty, Staff and Student Publications

INTRODUCTION: The COVID-19 pandemic has had a significant impact on mental health globally, with limited access to mental health care affecting low- and middle-income countries (LMICs) the most. In response, alternative strategies to support mental health have been necessary, with access to green spaces being a potential solution. While studies have highlighted the role of green spaces in promoting mental health during pandemic lockdowns, few studies have focused on the role of green spaces in mental health recovery after lockdowns. This study investigated changes in green space access and associations with mental health recovery in Bangladesh and Egypt across the …

Pregnancy-Related Factors Responsible For Delivering Low Birth Weight Babies: An Institutional-Based Cross-Sectional Study, Jamnagar, Gujarat, Harsh K Patel, Jitesh P Mehta, Bela A Patel, Rohitkumar Ram, Dipesh V Parmar

Faculty, Staff and Student Publications

BACKGROUND: The WHO defines LBW as "Birth weight less than 2500 grams" regardless of gestational age. Being born with a low birth weight also incurs enormous economic costs, including higher medical expenditures and social service expenses, and decreased productivity in adulthood.

OBJECTIVE: To study distribution of newborns' according to pregnancy related factors and its association with newborns' birth weight.

METHODS: An institutional based cross-sectional study. New-borns delivered at study institute were considered as study participants. Estimated final sample size was 500. Guardians (mothers) were face-to-face interviewed and also recorded data were collected from the case file and Mother and Child …

Dietary Practices Among Type 2 Diabetes Patients Visiting A Non-Communicable Disease (Ncd) Clinic In A District Of Western India: A Cross-Sectional Study, Bela Patel, Sumit Unadkat, Harsh Patel, Mittal Rathod

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: Diabetes is becoming a major public health problem in the country. One of the most important lifestyle modifications necessary for diabetic patients is maintaining healthy dietary choices. These modifications in dietary practices are supposed to be followed lifelong, along with medication, for better glycemic control. Despite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to these practices is poor. This study aimed to assess the dietary practices of type 2 diabetes mellitus (T2DM) patients and various factors that determine adherence to these healthy dietary practices. The secondary objective was to …

Willingness To Accept Monkeypox Vaccine And Its Correlates Among Men Who Have Sex With Men In Southern China: A Web-Based Online Cross-Sectional Study, Xinju Huang, Zhifeng Lin, Jiao Qin, Dee Yu, Fei Zhang, Ganggang Fang, Xi Chen, Jinfeng He, Ping Cen, Mu Li, Rongjing Zhang, Tong Luo, Junjun Jiang, Sanqi An, Hao Liang, Li Ye, Bingyu Liang

Faculty, Staff and Student Publications

BACKGROUND: The May 2022 global outbreak of monkeypox (MPX) poses a threat to the health of men who have sex with men. However, there is limited data on the willingness of MSM to receive monkeypox vaccination in Southern China. This study aimed to assess the knowledge of MPX, concerns regarding MPX, and willingness to receive monkeypox vaccination, as well as their correlates, among MSM in China.

METHODS: We conducted a Web-based online survey of MSM in Southern China from August to September 2022. Data were collected on the socio-demographic characteristics, knowledge, worries, concerns regarding MPX and willingness to receive monkeypox …

Promising Response Of Olaparib In Patient With Germline Atm-Mutated Metastatic Gastric Cancer, Kok Hoe Chan, Darius Rutazanaa, Curtis Wray, Nirav Thosani, Victor Yang, Putao Cen

Faculty, Staff and Student Publications

Gastric cancer ranks as the fifth leading cause of global cancer incidences, exhibiting varied prevalence influenced by geographical, ethnic, and lifestyle factors, as well as

Lactulose Vs Polyethylene Glycol For Bowel Preparation: A Single-Center, Prospective, Randomized Controlled Study Based On Bmi, Sun Wenqi, Zhao Bei, Wang Yunrong, Wu Xinrong, Li Yifan, Wang Weiwei, Ni Muhan, Yan Peng, Dou Xiaotan, Li Wen, Yang Hua, Wang Lei, Chen Min

Faculty, Staff and Student Publications

INTRODUCTION: Colonoscopy is currently considered as one of the principal techniques to diagnose the colorectal diseases. Admittedly, qualified bowel preparation before colonoscopy is a premise for high-quality examination. Lower quality bowel preparation might seriously impede visualization of the intestinal mucosa, resulting in missed and misdiagnosed intestinal lesions. Therefore, it is necessary to choose the appropriate oral laxative based on the guarantee of safety and efficacy.

METHODS: This prospective randomized controlled study was conducted to compare lactulose oral solution and polyethylene glycol (PEG) electrolyte powder for bowel preparation using the following indicators: Boston Bowel Preparation Scale, Bowel Bubble Score, detection rate …

Covid-19 Convalescent Plasma Therapy: Long-Term Implications, Hyunah Yoon, Yi Li, Keith S Goldfeld, Gia F Cobb, Caroline L Sturm-Reganato, Luis Ostrosky-Zeichner, Dushyantha T Jayaweera, Julie V Philley, Mahalia S Desruisseaux, Marla J Keller, Judith S Hochman, Liise-Anne Pirofski, Mila B Ortigoza

Faculty, Staff and Student Publications

BACKGROUND: The long-term effect of coronavirus disease 2019 (COVID-19) acute treatments on postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is unknown. The CONTAIN-Extend study explores the long-term impact of COVID-19 convalescent plasma (CCP) therapy on postacute sequelae of SARS-CoV-2 infection (PASC) symptoms and general health 18 months following hospitalization.

METHODS: The CONTAIN-Extend study examined 281 participants from the original CONTAIN COVID-19 trial (CONTAIN-RCT, NCT04364737) at 18 months post-hospitalization for acute COVID-19. Symptom surveys, global health assessments, and biospecimen collection were performed from November 2021 to October 2022. Multivariable logistic and linear regression estimated associations between …

Heterogeneity In Intrahepatic Macrophage Populations And Druggable Target Expression In Patients With Steatotic Liver Disease-Related Fibrosis, Omar A Saldarriaga, Timothy G Wanninger, Esteban Arroyave, Joseph Gosnell, Santhoshi Krishnan, Morgan Oneka, Daniel Bao, Daniel E Millian, Michael L Kueht, Akshata Moghe, Jingjing Jiao, Jessica I Sanchez, Heidi Spratt, Laura Beretta, Arvind Rao, Jared K Burks, Heather L Stevenson

Faculty, Staff and Student Publications

BACKGROUND & AIMS: Clinical trials for reducing fibrosis in steatotic liver disease (SLD) have targeted macrophages with variable results. We evaluated intrahepatic macrophages in patients with SLD to determine if activity scores or fibrosis stages influenced phenotypes and expression of druggable targets, such as CCR2 and galectin-3.

METHODS: Liver biopsies from controls or patients with minimal or advanced fibrosis were subject to gene expression analysis using nCounter to determine differences in macrophage-related genes (n = 30). To investigate variability among individual patients, we compared additional biopsies by staining them with multiplex antibody panels (CD68/CD14/CD16/CD163/Mac387 or CD163/CCR2/galectin-3/Mac387) followed by spectral imaging …

Resilience And Associated Factors In Orphaned And Separated Adolescents In Kenya: Understanding The Relationship With Care Environment And Hiv Risks., Sarah Sutherland, Harry Shannon, David Ayuku, David Kleiner, Olli Saarela, Lukoye Atwoli, Joseph Hogan, Paula Braitstein

Internal Medicine, East Africa

Orphans are at higher risk of HIV infection and several important HIV risk factors than non-orphans; however, this may be due to a combination of related social, psychological, and economic factors, as well as care environment, rather than orphan status alone. Understanding these complex relationships may aid policy makers in supporting evidence-based, cost-effective programming for this vulnerable population. This longitudinal study uses a causal effect model to examine, through decomposition, the relationship between care environment and HIV risk factors in orphaned and separated adolescents and youths (OSAY) in Uasin Gishu County, Kenya; considering resilience, social, peer, or family support, volunteering, …

Belzutifan, Hif-2Α Inhibitor, And Clear Cell Renal Cell Carcinoma With Somatic Von-Hippel-Lindau Loss-Of-Function Mutation, Kok Hoe Chan, Ningjing Li, Ran Lador, Mark Amsbaugh, Anneliese Gonzalez, Putao Cen

Faculty, Staff and Student Publications

The Von-Hippel-Lindau (VHL) gene, acting as a tumor suppressor, plays a crucial role in the tumorigenesis of clear cell renal cell carcinoma (ccRCC). Approximately 90% of individuals with advanced ccRCC exhibit somatic mutations in the VHL gene. Belzutifan, orally administered small-molecule inhibitor of hypoxia-induced factor-2α, has demonstrated promising efficacy in solid tumors associated with germline loss-of-function mutations in VHL, including ccRCC. However, its impact on cases with somatic or sporadic VHL mutations remains unclear. Here, we present 2 cases where belzutifan monotherapy was employed in patients with advanced ccRCC and somatic loss-of-function mutations in VHL. Both patients exhibited a swift …

Carbimazole-Associated Pancreatitis: Report From Western India, Vyankatesh Shivane, Nihar Mehta, Ajay Jhaveri, Saba Samad Memon

Faculty, Staff and Student Publications

Pancreatitis is a very rare complication of methimazole and carbimazole therapy. We describe a case of possible carbimazole-associated pancreatitis. A 41-year-old Asian man (with no comorbidities) reported to the hospital with atrial fibrillation and a fast ventricular rate. He was diagnosed with hyperthyroidism due to Graves disease. His rhythm was reverted with amiodarone, and carbimazole was initiated at 15 mg daily for the medical management of Graves disease. Fifteen days later, he presented with acute severe abdominal pain and vomiting with elevated serum amylase 387 U/L (reference range, 28-100 U/L) and lipase levels 206 U/L (reference range, 13-60 U/L). Magnetic …

Benign Disorders Of The Mediastinum: A Narrative Review, Saad Farooq, Sabiha Armin, Daniel Ocazionez, Rosa M Estrada-Y-Martin, Sujith V Cherian

Faculty, Staff and Student Publications

Background and objective: There are several benign processes that affect the mediastinum with considerable morbidity that may range from reactive entities to neoplastic disorders. This review article will focus on non-neoplastic benign mediastinal diseases which include large vessel vasculitis such as Takayasu and giant cell arteritis, mediastinal granulomas, fibrosing mediastinitis and mediastinal infections. These diseases can cause significant morbidity and mortality; therefore, we aim to familiarize readers with the pathophysiology, epidemiology and diagnosis of these mediastinal diseases and provide an update on the treatment options available.

Methods: We searched various databases such as PubMed and Google Scholar from August 2023 …