• Rapid PCR TB Testing Results in 68.5% Reduction in Unnecessary Isolation Days in Smear Positive Patients.

      Patel, Ravikumar; The University of Arizona College of Medicine - Phoenix; Saubolle, Michael (The University of Arizona., 2018-04-05)
      Acid-fast stain (AFS) of sputum smear is the standard initial test used to evaluate a patient with suspected tuberculosis (TB). Patients with positive AFS smears are normally started on TB medications and placed on TB airborne precautions during their hospital stay until the culture results are released (which can take 2-5 weeks) or patient is discharged. However, not all AFS positive smears indicate the presence of TB. Other acid fast microorganisms, especially the Non- Tuberculous Mycobacteria (NTM) can also result in AFS positive smear hence, there is a high preponderance of false-positivity for TB in smear tests. Infection with the NTM do not require medications specific for TB or airborne isolation precautions. However, due to the lack of a quick definitive TB test most AFS smear positive patients are started on TB meds and placed in airborne isolation leading to inappropriate management of patients including unnecessary isolation, possible extension of hospital stay and increased cost. This is a prospective quality improvement study. Between Nov 2016 and August 2017 a Cepheid PCR test was performed on all AFS sputum smear positive patients from the initial sputum specimen collected on hospital admission. Background data between 2014 and 2016 was also collected for comparison prior to introduction of PCR testing. Data was used to evaluate unnecessary isolation for Smear positive patients.
    • Rapidity of Coccidioidomycosis Diagnosis and Its Effect on Healthcare Utilization.

      Mohty, Ralph; The University of Arizona College of Medicine - Phoenix; Bollmann, KeriLyn (The University of Arizona., 2018-04-05)
      Background: Coccidioidomycosis is an infection caused by the fungal Coccidioides species common to Central and South America, and the southwestern United States, with Arizona claiming the vast majority of U.S.-based cases. Recognizing and diagnosing coccidioidomycosis is often difficult, with the wide range of symptoms being commonly misdiagnosed as a bacterial community-acquired pneumonia. Misdiagnosis and a delay in true diagnosis leads to ineffective, costly, and burdensome ramifications. Data investigating the diagnostic delay of Coccidioidomycosis could provide means for future changes in clinical practice. Methods: This is a two-phase study: phase one assessed disease markers and symptomatology, and phase two analyzing healthcare utilization based on electronic medical record data extraction of 139 patients. Results: The mean and median for 0-30 days of delay was $6,273 and $770 respectively; this increased at 151-183 days of diagnostic delay to $57,724 and $8,917 respectively. Small final population size precluded meaningful statistical analysis. Conclusion: Demonstrating diagnostic delay characteristics for patients with coccidioidomycosis is possible, however due to small final population size and difficulties encountered due to the innate properties of the electronic medical record, future investigation and optimization will be necessary for more powerful analysis.
    • Rattlesnake Envenomations Treated Without Antivenom

      Chang, Phoebe; The University of Arizona College of Medicine - Phoenix; Curry, Steven (The University of Arizona., 2018-03-28)
      The standard treatment for rattlesnake envenomation (RSE) is antivenom. The clinical course of patients treated with antivenom is well described. Prior to 2000, only a whole IgG AV (IgGAV) associated with high rates of hypersensitivity reactions (HSS) was available to treat RSE. Since 2000, Crotalidae Polyvalent Immune Fab (FabAV), which has a better safety profile than IgGAV, has been primarily used. Patients with RSE may not be treated with AV for a variety of reasons including history or perceived risk of HSS, patient refusal, drug shortage, or clinical impression that AV is not indicated. Research Question: What outcomes are associated with moderate to severe RSEs treated without antivenom?
    • Regulation of an Axonal Guidance Protein, Neuro Navigator 3, in Amyotropic Lateral Sclerosis

      Kousari, Arianna; The University of Arizona College of Medicine - Phoenix; Bowser, Robert; Bakkar, Nadine (The University of Arizona., 2018-02-26)
      Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting upper and lower motor neurons. Neuron Navigator 3 (Nav3) is a member of the Navigator family of proteins that function as microtubule-binding proteins. Nav3 is primarily expressed in brain tissue and neuromuscular junctions, and is thought to play a significant role in neuron regeneration and axonal outgrowth. An unbiased proteomic study looking at ALS and control cerebrospinal fluid (CSF) identified Nav3 to be significantly upregulated in ALS compared to controls. This study aimed to validate these findings using immunohistochemistry (IHC), Real-Time PCR, and western blot to determine if Nav3 was increased in brain and spinal cord tissue from ALS patients, primary rat motor neurons, and in the SOD1G93A mouse model.
    • A Retrospective Analysis of Intra-ocular Pressure Changes after Cataract Surgery with the use of Prednisolone Acetate 1% versus Difluprednate0.05%

      Kusne, Yael; The University of Arizona College of Medicine - Phoenix; Fintelmann, Robert (The University of Arizona., 2018-04-05)
      Cataract surgery is the most common eye procedure performed in the United States. Steroids are routinely used post-operatively to decrease inflammation. Steroids have been shown to increase intraocular pressure (IOP). Here, we present the findings of a retrospective analysis comparing two commonly prescribed steroid agents and their effect on post-operative IOP.
    • Role of Lung Clearance Index in the Early Detection of Pulmonary Changes in Children with Sickle Cell Disease

      Chaung, Monica; The University of Arizona College of Medicine - Phoenix; Williams, Sophia (The University of Arizona., 2018-03-30)
      Pulmonary complications including acute chest syndrome are leading causes of sickle cell disease related morbidity and mortality. Studies have shown that pulmonary changes can be detected during childhood. Spirometry is the current standard for measuring lung function. Growing evidence suggests that lung clearance index (LCI) is as sensitive as spirometry in identifying pulmonary changes in pediatric patients. Our cross-sectional study compared the sensitivity of LCI to spirometry in the detection of early pulmonary changes in children with sickle cell disease. Our results show that LCI significantly correlates to FEV1% predicted (Spearman’s coefficient -0.44, p = 0.003), FVC % predicted (Spearman’s coefficient -0.44, p = 0.006) and FEF25-75 (Spearman’s coefficient -0.49, p <0.001). Using receiver operating characteristic (ROC) curves, LCI was found to be more sensitive than spirometry, but less specific. The data support LCI’s use as a test to screen for pulmonary changes in children with sickle cell disease. Earlier monitoring of lung function will allow for preventative therapies and delayed progression of pulmonary dysfunction.
    • Self-Esteem in Primigravida Women

      John, Jabez; The University of Arizona College of Medicine - Phoenix; Manriquez, Maria (The University of Arizona., 2018-03-30)
      Hormonal and related biological changes associated with giving birth may initiate or precipitate a change in self-esteem. Alternatively, or additionally, the change in lifestyle associated with caring for a young infant, for example changes in normal daily activities, lack of sleep caring for the infant, change in financial security, change in the relationship with her partner, may constitute a set of stresses that have mental health consequences for the mother. Since primigravida women have no previous personal experience with childbirth they might have less of a coping strategy to deal with their emotional changes during childbirth.
    • Self-Reported Depression, Anxiety, and Adverse Educational Experiences in Youth Ages 7-18.

      Molina, Cris Jacob; The University of Arizona College of Medicine - Phoenix; Weller, Jennifer (The University of Arizona., 2018-04-05)
      Psychiatric symptoms of depression and anxiety can have profound and lasting effects on a growing child. Children spend much of their time in school, where significant anxiety and depressive disorders may impair children’s ability to learn, socialize, and thrive. It is already known that depression and anxiety can compromise memory and other cognitive functions.1 The Children’s Depression Inventory (CDI) and the Revised Children’s Manifest Anxiety Scale (RCMAS), self-report measures of depression and anxiety in youth, were used to assess symptoms of depression and anxiety in an outpatient clinical sample. Scores on these instruments were correlated with parent report of children’s significant educational events (e.g., evaluation for eligibility for special education services, enrollment in special education services, and repeating a grade). The goal of the study was to investigate the relationship between self-reported depression and anxiety and adverse educational experiences. The hypothesis was that children with higher depression and anxiety scores would have greater occurrence of adverse educational events compared to those with lower scores. Results of multiple logistic regression analyses were mixed. Future studies using larger sample sizes may have the potential to identify youth at risk of adverse educational experiences due to anxiety and depressive symptoms.
    • SURGICAL TASK-SHIFTING IN AFRICA: A COMPREHENSIVE AND SYSTEMATIC REVIEW

      O'Connor, Devin; The University of Arizona College of Medicine - Phoenix; Brady, Michael (The University of Arizona., 2018-04-10)
      Background This systematic review focuses on discussing the critical shortage of surgeons and access to surgical services in many low income African nations and the difficulties encountered by non-physician clinicians who are trained to increase the surgical workforce by carrying out less severe surgeries and peri-operative care. By critically assessing the literature this review seeks to present the benefits to surgical task shifting and the most commonly encountered problem with this type of healthcare intervention
    • Survey Determining Involvement of Certified Athletic Trainers in Return to Activity/Play Decisions and Concussion Education

      Olla, Danielle; The University of Arizona College of Medicine - Phoenix; Handmaker, Hirsch (The University of Arizona., 2018-04-10)
      In the some states a Certified Athletic Trainer (AT) has the ability to determine if a player can return to activity or play (RTP) following a mild Traumatic Brain Injury (mTBI), also known as a concussion. Premature return to activity or RTP and sustaining another concussion can result in further axonal damage, prolonged complications and rarely, death. There currently is no standardized education and certification for ATs regarding concussion management, and no data exists determining how often ATs are involved in return to activity or RTP decisions. The aim of this study was to survey ATs and establish a baseline of their involvement in return to activity and RTP decisions and determine what type and amount concussion education ATs are completing at the present time. A twenty (20) question electronic survey was sent to 2084 randomly selected ATs registered with the National Athletic Trainer Association (NATA). 382 responses were collected in a 38‐day period. The survey was successfully completed by a total of 356 ATs from across the United States.
    • A Systematic Review of the Risk of HIV Transmission with Concurrent Schistosomiasis Infection

      Lee, Anne; The University of Arizona College of Medicine - Phoenix; Beyda, David (The University of Arizona., 2018-04-05)
      Schistosomiasis and HIV are both significant causes of morbidity in low resource settings worldwide, particularly in Sub-Saharan Africa. Research has indicated that there may be a link between the two infections--specifically that schistosomiasis infection may be a risk factor for HIV transmission. After a comprehensive review was performed to understand current knowledge in the field, a systematic review with meta-analysis exploring the interaction of the two infections was conducted to analyze this relationship. An exhaustive search in PUBMED and Google Scholar of was conducted with search terms related to schistosomiasis and HIV, and studies that were published within the past 30 years in English were included. In
    • Targeted Treatment on PTEN Mutated GBM Cell Lines using Metformin and Chlorpromazine

      Grecu, Iulius; The University of Arizona College of Medicine - Phoenix; Tran, Nhan (The University of Arizona., 2018-02-26)
      Glioblastoma multiforme (GBM) is among the most aggressive and lethal of all human cancers. Characteristically, GBM is genetically heterogenous with different tumors portions exhibiting vastly different genetic profiles. Due to this, GBM patients are plagued with poor prognosis and high recurrence rates. Within the last decade there has been an increase in knowledge of the molecular finger print of GBM but improvement in patient outcome has been slow as personalized treatment regimens have not been linked to significant improvement. However, there is hope with feasible multiagent personalized regimens as well as expanding the amount of treatment options with repurposed agents and immunologic modulators improving patient outcomes. One hypothesized gene of interest in tumor development and progression is PTEN. In this study we investigate two repurpose agents Metformin and Chlorpromazine which are thought to depress downstream oncogenic proteins specific to the PTEN pathway using a cell culture model. For this study four Xenograft cell lines with differing PTEN status were treated with titrated concentrations of Metformin and Chlorpromazine. After treatment, results were quantified by SiRNA function using cell-titer glo assay a marker for cell viability.
    • Transcriptional Regulation of the Type 1 Interferon Response by a Nuclear Pore Protein.

      Aintablian, Haig; The University of Arizona College of Medicine - Phoenix; Gustin, Kurt (The University of Arizona., 2018-03-28)
      The type I interferon (IFN) response is an integral immune response for host defense against viruses. When a virus enters a cell, cellular pattern recognition receptors bind to viral structures leading to transcription and synthesis of interferons ultimately resulting in viral clearance (5). More than twenty unique IFN genes have been found in humans. They are typically divided among three classes, simply labeled Type I IFN, Type II IFN, and Type III IFN. Interferons belonging to all three classes are important for fighting viral infections and for the regulation of the immune system. Specifically, the type I interferons are produced when cells recognize viral particles within them. Simply put, this response, which results in the production of IFN- β, is akin to an alarm being sounded, alerting the body to viral invasion. The transcriptional induction of IFN- β requires numerous signaling molecules that converge on the activation pathways of various transcription factors, ultimately leading to the antiviral response. Although well studied, many components of the type I interferon response are still being deciphered.
    • Uncomfortable at best and dehumanizing at worst: The experience of transgender men seeking reproductive and family planning care

      Geiger, Alex; The University of Arizona College of Medicine - Phoenix; Coles, Sarah (The University of Arizona., 2018-02-26)
      Transgender men face significant barriers in accessing culturally-sensitive reproductive and family planning care, and as a result, are less likely to be up to date on recommending reproductive health screenings. It is unclear whether the primary barrier is health knowledge (HK) or comfort seeking care (CSC), or communication barriers with their provider(PC). An eighteen-item survey (n=221) was designed to assess these three factors. While the vast majority of participants had high levels of health literacy, nearly half of participants would not feel comfortable seeking reproductive healthcare or family planning care (48.5%). Improved CSC and PC were found among transgender men that receive care at locations that primarily treat LGBTQ-patients. Participants self-reported barriers included poor provider training/knowledge on transgender health, assumptions made by providers, and fear of seeking care due to discrimination. The results of this study indicate a need for improved provider education and highlight significant barriers that exist for transgender men seeking reproductive healthcare.
    • An Unusual Complication of Gastrografin®: Gastric Precipitation

      Bergin, Edward; The University of Arizona College of Medicine - Phoenix; VanSonnenberg, Eric (The University of Arizona., 2018-04-10)
      Gastrografin®, an oral contrast agent, is important for non-operative management of small bowel obstruction and post-operative ileus. However, Gastrografin® can cause complications with its propensity to precipitate in an acidic environment. We describe a case of Gastrografin® precipitation in the stomach that resulted from delayed gastric emptying and increased gastric acid secretion in an elderly woman.
    • Using Hyperopia Measurements to Predict Need for Surgery in Children with Accommodative Esotropia

      Jones, Nathan; The University of Arizona College of Medicine - Phoenix; Salevitz, Mark (The University of Arizona., 2018-03-30)
      Background: Esotropic strabismus is a condition in which the eyes are not properly aligned with each other. In children, uncorrected esotropia may result in permanent loss of vision due to amblyopia, a condition where the nonpreferred, crossing eye is suppressed. Early identification and treatment of esotropia in children is critical, as doing so may prevent permanent loss of vision.
    • Why do Physicians Volunteer at Medical Schools and Free Clinics?

      Eid, Tarek; The University of Arizona College of Medicine - Phoenix; Briney, Stephanie (The University of Arizona., 2018-03-28)
      Purpose To understand the reasons why physicians volunteer their time to provide healthcare to the uninsured and to educate future physicians. Another goal is to define the barriers that prevent physicians from volunteering. Background Physician volunteers play an integral role in educating medical students and providing health care to the uninsured. Therefore, understanding the reasons why physicians volunteer their time can possibly improve recruitment procedures. It may help clinics and medical schools advertise to prospective volunteer physicians by emphasizing the positives and directly addressing the main concerns in volunteering. Materials and Methods A survey was distributed to physicians from multiple specialties who work at the University of Arizona College of Medicine – Phoenix and Banner University Medical Center – Phoenix. The survey consisted of questions regarding physicians’ background information, volunteer experience, barriers to volunteerism, and motivation behind their volunteerism. Motivation was evaluated utilizing a validated and widely used survey called the Volunteer Functions Inventory (VFI). Results A total of 100 physicians responded to the survey. 84% of physicians cited “lack of time” as being the primary barrier to volunteerism. 25% and 22% of the physicians cited “Financial Costs” and “Unaware of Opportunity” as barriers, respectively. With respect to VIF components, the “Values” category showed the highest score of 30.38 out of a possible 35 ,while “career factors” observed the lowest score of 14.09 Conclusions Medical schools and clinics could possibly improve their recruitment efforts by making it less time consuming for physicians to volunteer and by minimizing the financial costs to physicians. They could also benefit by advertising the altruistic and humanitarian nature of the volunteer activity.