Translational Medical Research Commons^™

Defining Early And Late Clinical Outcomes In Patients With Sars-Cov-2 Pneumonia, Julio A. Ramirez, Jose Bordon, Rodrigo Cavallazzi, Stephen P. Furmanek, Jiapeng Huang, Timothy L. Wiemken, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

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 …

Ap-1 And Nf-Κb Synergize To Transcriptionally Activate Latent Hiv Upon T-Cell Receptor Activation., Joseph Hokello, Adhikarimayum Lakhikumar Sharma, Mudit Tyagi

Center for Translational Medicine Faculty Papers

Latent HIV-1 proviruses are capable of reactivating productive lytic infection, but the precise molecular mechanisms underlying emergence from latency are poorly understood. In this study, we determined the contribution of the transcription factors NF-κB, NFAT, and AP-1 in the reactivation of latent HIV following T-cell receptor (TCR) activation using Jurkat T-cell clones harboring single latent HIV proviruses. Our findings demonstrate that during reactivation from latency, NF-κB enhances HIV transcription while NFAT inhibits it by competing with NF-κB for overlapping binding sites on the HIV long terminal repeat (LTR). We have also demonstrated for the first time the molecular contribution of …

International Respiratory Infections Society Covid Research Conversations: Podcast 1 With Dr. Francesco Blasi, Julio A. Ramirez Md, Francesco Blasi Md, Phd

The University of Louisville Journal of Respiratory Infections

Section(s) Topics

1–2 Introductions

3 Foundations of best practice

4 COVID-19 as stimulus for innovation

5 Adapting and evolving therapeutic approach

6 Age and comorbidities as risk factors

7 Over-capacity ICU

8 Adapting the ER for COVID-19

9 Training personnel for COVID-19

10 Psychological support, healthcare heroes, and COVID fatigue

11 Increased oxygen requirement

12–13 Milan’s multi-disciplinary unit

14 Standardizing respiratory support measures

15 Nutrition, sedation, and life support

16 CPAP successes and failures

17 Prone and lateral positioning of patients on CPAP

18 Different COVID-19 phenotypes?

19 Thromboembolism risk score, age, and comorbidities

20 Cardiorespiratory considerations: hypertension, echocardiography

21 …

An Update On The Leading Covid-19 Vaccines, Ahmed A. Eladely, Javaria Anwer Mbbs, Ashwini Gotimukul Mbbs, Manish Kc Mbbs, Jessica Petrey Msls, Alex Glynn Ma, Ruth M. Carrico Phd, Dnp, Julio A. Ramirez Md

The University of Louisville Journal of Respiratory Infections

We reviewed the COVID-19 vaccines that reached phase III of clinical development. For each of the 10 vaccines identified, we described the technology used for vaccine development, the available data from phase III clinical trials, data on vaccine safety, and the role of new SARS-CoV-2 variants on vaccine efficacy.

Detection And Profiling Of Human Coronavirus Immunoglobulins In Critically Ill Coronavirus Disease 2019 Patients, Douglas Fraser

Data and Test Instruments

No abstract provided.

Chloroquine: Autophagy Inhibitor, Antimalarial, Bitter Taste Receptor Agonist In Fight Against Covid-19, A Reality Check?, Pawan Sharma, Kielan D. Mcalinden, Saeid Ghavami, Deepak A. Deshpande

Center for Translational Medicine Faculty Papers

The recent SARS-CoV-2 pandemic poses one of the greatest challenges to modern medicine. Therefore, identification of new therapeutic strategies seems essential either based on novel vaccines or drugs or simply repurposing existing drugs. Notably, due to their known safety profile, repurposing of existing drugs is the fastest and highly efficient approach to bring a therapeutic to a clinic for any new indication. One such drug that has been used extensively for decades is chloroquine (CQ, with its derivatives) either for malaria, lupus and rheumatoid arthritis. Accumulating body of evidence from experimental pharmacology suggests that CQ and related analogues also activate …

Impact Of A Multidisciplinary Group On Management Of Patent Foramen Ovale In Cryptogenic Stroke And Outcome Measures: A Retrospective Study, Laura Meissner, Diana L. Tzeng, Md

Phase 1

Patent foramen ovale (PFO) is a common cardiac abnormality present in roughly 25% of the adult population. Although typically benign, patients with a PFO account for 50% of the population of cryptogenic stroke, an ischemic stroke with an unknown cause. Guidelines suggest closure in patients with a cryptogenic stroke found to have a PFO; however, it is unclear whether medical treatment should be given to all patients, regardless of PFO closure, and data is limited on the treatment outcomes. This retrospective chart analysis of 80 patients with a cryptogenic stroke found to have a PFO will investigate the criteria a …

Genetic Profiling Of Cell Types In The Pathogenesis Of Nonalcoholic Steatohepatitis (Nash), Yanki Yarman, Raj Vadigepalli

Phase 1

NASH is the progressive form of non-alcoholic fatty liver disease (NAFLD) which affects 25% of adults in the US. We are interested in identifying genetic markers for specific cell populations in the liver and hypothesize that cells undergo genetic reprogramming to handle the molecular stresses of the NASH disease state.

Using previously published single-cell RNA sequencing datasets from mouse liver whole tissue, we identified the top 25 most highly variable genes per cell type in NASH liver tissue. Using R-programming language, datasets from both healthy and diseases livers were deconvoluted, normalized, linearized and dimensionally reduced to create a 3D map …

Evaluating Barriers To Clinical Trial Enrollment In Head And Neck Surgical Oncology, Gregory Schneider, Emily Sagalow, Kealan Hobelmann, Md, Richard Goldman, Md, David Cognetti, Md, Joseph M. Curry, Md, Adam Luginbuhl, Md

Phase 1

Introduction and Objectives: Clinical trials are an important focus in academic otolaryngology practices, but busy practices may pose difficulty for identification and enrollment of patients eligible for trials. We will identify barriers to enrollment from the perspective of both head and neck surgical oncologists and their patients.

Methods: Patients who were eligible for any of the eight clinical trials offered at Jefferson between August and November 2020 were identified. We utilized an Epic EMR phrase to capture if a trial was offered or not and why, whether a patient refused enrollment and why, and patient wait time.

Results: During the …

Reduced Recovery Times With Total Intravenous Anesthesia In Patients With Obstructive Sleep Apnea, Leonard Estephan, Matthew Stewart, Maurits Boon, Colin Huntley

Phase 1

Introduction: There are currently no specific anesthetic guidelines for patients with obstructive sleep apnea (OSA) undergoing upper airway surgery. Two consistently utilized anesthetic approaches during such procedures include inhalational gas anesthesia and total intravenous anesthesia (TIVA), however whether either is more efficacious remains undefined. We hypothesize that administration of TIVA will lead to reduced post-operative recovery time in patients with comorbid OSA undergoing upper airway surgery.

Methods: A retrospective chart review was performed for patients with comorbid OSA that underwent surgery (upper airway stimulation, nasal surgery, palate surgery) between January 2019 and December 2019. Included patients received either inhaled …

A Comparative Analysis Of Anterior & Lateral Cranial Base Csf Leaks, Rahul Alapati, Glen D. Souza, Md, Prachi Patel, Chandala Chitguppi, Md, Rashiqah Syed, Tawfiq Khoury, Md, Mindy R. Rabinowitz, Md, Christopher J. Farrell, Md, Elina Toskala, Md, Phd, Marc R. Rosen, Md, James J. Evans, Md, Gurston Nyquist, Md

Phase 1

Introduction

The optimal strategy for management of Idiopathic Intracranial Hypertension (IIH) in anterior and lateral cranial base meningoencephaloceles remains debated. The purpose of this study is to present a comparison of the surgical management of anterior and lateral cranial base meningoencephalocele and a treatment algorithm for the diagnosis and management of IIH in this patient population.

Methods

Retrospective study of 109 patients who underwent anterior or lateral CSF leak repair at TJU from 2004-2020. Epic & RedCap were utilized to record data. Patient demographics, presenting symptoms, imaging, Beta-2 Transferring testing, surgery, repair, and post-op data were collected. Two-sided Chi-squared tests …

Comparison Of Endovascular Therapy Versus Medical Therapy In The Management Of Descending Thoracic Aortic Dissection, Eli Cehelyk, Babak Abai, Md

Phase 1

Introduction: This retrospective review aimed to compare clinical outcomes between patients with descending aortic dissections, with and without organ malperfusion, who were managed with thoracic endovascular aortic repair (TEVAR) or best medical therapy (BMT).

Methods: Thirty-eight patients diagnosed with descending aortic dissections between 2013 and 2020 were identified for analysis. Patients with dissection secondary to trauma and death unrelated to cardiothoracic pathology were excluded. Participants were divided into three groups based on their management: TEVAR (without side branch stenting), TEVAR+ (with additional branch stenting) and BMT. The primary outcome measure was length of hospital stay (LOS) and statistics were analyzed …

Otologic Opioid Usage And Pain Control In The Postoperative Period, Matthew Stewart, Eric Mastrolonardo, Joann Butkus, Raphael Banoub, Md, Tingting Zhan, Phd, Sophia Dang, Md, David Cognetti, Md, Rebecca Chiffer, Md, Thomas Wilcox, Md

Phase 1

Introduction: Patients’ unused prescription opioids can be diverted and increase the overall opioid burden on society. Therefore, otolaryngologists can reduce opioid influx by minimizing excess tablets in opioid prescriptions. We hypothesize that otology patients at TJUH receive more opioid tablets than needed to effectively manage postoperative pain.

Methods: Patients ages ≥18 years old who received otologic surgery at TJUH were included in this prospective observational study between November 2019 and August 2020. Patients were provided a survey for recording pain on postoperative days 0, 1, 3, and 7 and the amount of remaining opioids from their prescription. Opioid amounts were …

Postoperative Opioid-Prescribing Practices In Nasal Surgery: A Prospective Study, Brian M. Yan, S. Hamad Sagheer, Cory D. Bovenzi, Uche Nwagu, David Cognetti, Howard Krein, Ryan Heffelfinger

Phase 1

Introduction: Within facial plastic and reconstructive surgery (FPRS), prescription practices have trended toward prescribing larger amounts of perioperative opioids. However, there is limited literature regarding the postoperative pain experience and opioid consumption for FPRS. The purpose of our study was to investigate opioid prescription and consumption following procedures of the nose, with the aim of developing evidence-based guidelines for postoperative pain management.

Methods: In this prospective single center study, morphine milligram equivalents (MME) consumption and pain scores were collected in 72 patients who underwent nasal surgery. Patient demographics, MME use, and pain scores were examined. MME use was compared …

Differences In Clinical And Functional Outcomes Between Osteochondral Allograft Transplantation And Autologous Chondrocyte Implantation When Used In The Treatment Of Focal Grade 3 And Grade 4 Articular Cartilage Defects, Daniel Abraham, Joseph Brutico, Kashyap Chauhan, Anant Dixit, Fotios Tjoumakaris, Brad Tucker, Kevin Freedman

Phase 1

Introduction:

Grade 3 and 4 articular cartilage defects involve 50% of cartilage thickness without involvement of the underlying bone. There are several available options for the surgical repair of articular cartilage lesions including osteochondral allograft transplantation (OCA), a well-established procedure, and autologous chondrocyte implantation (ACI), an alternative developed more recently. Although there are studies examining ACI outcomes, there hasn’t been significant comparison of ACI outcomes to other procedures, including OCA. The inquiry question of this study was: how do clinical and functional outcomes differ between patients with focal articular cartilage defects treated with ACI and patients treated with OCA? …

Total Knee Arthroplasty In Patients With Prior Meniscus Surgery: A Matched Case Control Study, Lasya Rangavajjula, Steven B. Cohen, Md, Meghan E. Bishop, Md, Shyam Brahmabhatt, Md, Michael G. Ciccotti, Md, Ashley Bassett, Md, Christopher Hadley

Phase 1

Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts.

Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and …

Establishing The Relationship Between Mendelian Nafld And Skin Pathology, Anthony Medvedev, Hassan Vahidnezhad, Phd, Leila Youssefian, Phd, Jouni Uitto, Md, Phd

Phase 1

Introduction:

It is estimated that 25% of the world’s population has some form of Nonalcoholic Fatty Liver Disease (NAFLD), a pathology associated with the development of cirrhosis, varices, and hepatocellular carcinoma. The discovery of a biallelic mutation in ABHD5 established the link between NAFLD and Chanarin-Dorfman syndrome. Consequently, it was hypothesized that additional NAFLD-inducing mutations could be associated with dermatologic manifestations.

Methods:

International NAFLD patients from consanguineous families underwent whole exome sequencing. These results were then filtered by frequency and pathogenicity prediction algorithms (e.g. Mutation Taster, Polyphen, CADD) to yield novel mutations. Concurrently, a literature review via PubMed identified …

Risk Factors And Effect Of Acute Kidney Injury On Outcomes Following Total Hip And Knee Arthroplasty, Zachary S. Aman, Michael Yayac, Alexander J. Rondon, Timothy L. Tan, P. Maxwell Courtney, James J. Purtill

Phase 1

Introduction: Development of acute kidney injury (AKI) following primary total joint arthroplasty (TJA) is a potentially avoidable complication associated with negative outcomes including increased length of stay and mortality. The purpose of this study was to determine the effect of AKI on short-term outcomes and identify risk factors for developing AKI following either total hip or total knee arthroplasty. It was hypothesized that AKI has significant adverse effects on short-term outcomes metrics.

Methods: Patients undergoing primary TJA at a single hospital from 2005 to 2017 were identified and patient demographics, comorbidities, short-term outcomes, and perioperative laboratory results were recorded. …

A Single Academic Center's Experience With Direct Access Colonoscopy, Rachel Israilevich, Mary White, Sophia Lam, Benjamin Chipkin, David Kastenberg, Md

Phase 1

Introduction: Direct Access Colonoscopy (DAC) does not require pre-colonoscopy consultation and may improve access for patients needing screening and surveillance. DAC eligibility criteria vary widely, and we developed a novel, DAC program using EMR patient data to assess appropriateness for inclusion. This study aimed to evaluate the efficacy and quality of our DAC program and compare to traditional, Office-Scheduled Colonoscopy (OSC).

Methods: We conducted a retrospective, single-center study of OSC and DAC patients ages 45-75 with a screening or surveillance indication over 13 months. Primary outcome was Complete Colonoscopy (CC): to cecum/ileum/anastomosis, adequate prep, < 90 days from gastroenterology contact. Patients not meeting CC criteria were classified as Incomplete Colonoscopy (IC). Secondary endpoints: time to CC, adenoma detection rate (ADR).

Results: 2,651 patients met …