• The Effects of Calcium Supplementation on the Incidence of Preeclampsia on Pregnant Women in Developing Countries

      Sobhanian, Nura; The University of Arizona College of Medicine - Phoenix; Coonrod, Dean; Ali, Nyima (The University of Arizona., 2018-02-28)
      Preeclampsia is one of the most common pregnancy complications in lower income countries. It can evolve into eclampsia if not treated, which leads to maternal death. Preeclampsia is a global issue; however, the incidence is seven times higher in lower income countries. Calcium supplementation has been thought to play a role in the reduction of preeclampsia in pregnant women and act as a method of early detection. The purpose of this project was to determine whether this intervention reduces the incidence of preeclampsia in pregnant women in low and middle income countries. In order to do this, we examined existing data on calcium supplementation as well as clinical trials through PubMed searches. Each study examined was performed in a low or mid income country, and compared with women in that area who did not receive the intervention. The results of this project do indicate a decrease in the incidence of preeclampsia with calcium supplementation.
    • "El viaje al otro lado: Relationship between Depression Onset in Latinas and Immigration Experience Coming to the United States”

      Rubin, Arielle; The University of Arizona College of Medicine - Phoenix; Moreno, Francisco (The University of Arizona., 2018-04-06)
      Background: Few studies investigate unique psychosocial hardships and trauma during immigration by mode of travel. This retrospective pilot study explores the trauma and hardship during different types of immigration travel among Latina women and explores its relationship to psychiatric diagnosis in Latina immigrant women with and without psychiatric diagnosis history. Conclusion: In this small pilot study, “coyote” travel significantly correlated with trauma exposure. There was a numerical suggestion that coyote travel is more often associated with depression than non-coyote travel. With only 14 individuals this pilot study had limited power to detect effects. The lack of difference in depressive symptomatology one year after arrival between the group of people previously diagnosed and community volunteers suggest a multifactorial high-risk adjustment period warranting a high-degree of clinical suspicion and screening in all newly immigrated patients.
    • Emergency Department Volunteers: Defining the position and its effect on the Patient Experience

      Heller, Paul; The University of Arizona College of Medicine - Phoenix; Samaddar, Kris (The University of Arizona., 2018-03-30)
      Research Question: Will trained volunteers significantly affect patient experience compared to educational fliers or no intervention? Background: Patient experience continues to be an important issue with our nation’s healthcare system especially with the adoption of Value Based Purchasing for hospital reimbursement. With the use of Honor Health Scottsdale’s large number of volunteers, we hoped to design and develop a program that will improve experience for patients presenting to a community based Emergency Department. Objective: To evaluate the impact of Emergency Department Volunteers on the patient experience.
    • Epidemiology of Post-Traumatic Brain Injury-Induced Hypothalamic Pituitary Dysfunction in Arizona AHCCCS Patients

      Sukhina, Alona; The University of Arizona College of Medicine - Phoenix; Lifshitz, Jonathan (The University of Arizona., 2018-04-09)
      Introduction: Traumatic brain injury (TBI) in children can result in cognitive, emotional and somatic neurological impairments. In adults, post-traumatic hypopituitarism can extend or exacerbate these impairments, likely due to mechanical damage to the pituitary and hypothalamus. The pituitary in the pediatric brain likely suffers similar mechanical damage, inducing endocrinopathies as in adults, but injury-induced endocrinopathies are infrequently reported in children. Unrecognized hypopituitarism may lead to elevated risks of metabolic syndrome, diabetes, delayed or absent puberty, short stature, and other endocrinopathies. However, screening for endocrine deficiencies in susceptible patients and initiating appropriate hormone replacement therapy may prevent these sequelae and improve the prospects for recovery. Results: We determined that TBI victims were 3.18-times higher risk of developing a central endocrinopathy compared with the general population (CI=0.264), pediatric AHCCCS patients with a central endocrinopathy had a 3.2-fold higher odds of a history with TBI than those without a central endocrinopathy (CI=0.266), of the central endocrinopathy in TBI victims is attributable to the TBI, and the number of patients who need to be exposed to a TBI for 1 patient to develop an endocrinopathy was 154.2 (CI=7.11). We also determined that more males than females presented with central endocrinopathies after TBI compared with the general population of TBI victims.
    • Evaluation of TEMS Support Efficacy in Four Representative Tactical Units

      Weidenbach, Kimberly; The University of Arizona College of Medicine - Phoenix; Somal, Jasjeet (The University of Arizona., 2018-02-28)
      Background/Significance: Tactical Emergency Medical Support (TEMS) is a service modified from military tactical medicine to encompass the complex environment and mission set of current law enforcement agencies. Physicians and certified personnel acting as TEMS must be able to provide medical care under stressful and dangerous conditions as well as train police to be able to care for themselves when needed. A physician on-scene during a mission can provide deeper medical knowledge and abilities in the event that injuries or the complications thereof go beyond the training of paramedics. By working closely with the operational team, TEMS also have the opportunity to foresee possible risks and advise the team leader during planning stages. Tactical medicine also allows for preventative medical training, advising on anything from diet, hydration, and exercise plans to treatment of acute hemorrhage in the field.
    • Evaluation of Thin-Slice Axial Magnetic Resonance Imaging on the Diagnostic Accuracy of Meniscus Tears

      Albert, Andrew; The University of Arizona College of Medicine - Phoenix; Leung, Jimmy (The University of Arizona., 2018-03-28)
      This investigation assessed the diagnostic accuracy of thin-slice (1mm) axial Magnetic Resonance Imaging (MRI) in the detection and classification of meniscal tears. Meniscal injuries are a common reason for knee pain and the use of MRI has become standard in their assessment. However, the classification of tears and not merely the detection of lesions has become increasingly important to surgeons in deciding between surgery and conservative management. There is a growing body of literature examining the utility of axial MR images in aiding radiologists to more accurately describe and classify morphological characteristics of meniscus tears. However, the thick- slice (4-5mm) axial sequences utilized at many institutions typically only produce 1-2 images on which the menisci can be visualized, which does not provide the required detail to accurately describe the morphological characteristics of meniscal lesions. This study adds to the growing body of literature examining the diagnostic capabilities of MRI with TSAi to accurately describe meniscal tear morphologies. Imaging reports from 107 patients with clinically suspected meniscus injuries who underwent MRI with thin-slice axial imaging were compared to arthroscopic findings using receiver operating characteris (ROC) analysis to assess the diagnostic accuracy of MRI with thin- slice axial imaging (TSAi). The sensitivity and specificity of MRI with TSAi for meniscal tear detection were found to be 91% and 37.5% respectively. Furthermore, MRI with TSAi was highly specific for bucket handle (98.5%) and root ligament tears (94.1%). The findings of our investigation indicate that MRI with TSAi may assist surgeons in determining the need for operative versus conservative management. MRI with TSAi may be particularly helpful in the case of root tears, which were not as readily identified with traditional MRI techniques and often require surgical intervention due to morbidity associated with unrepaired root tears.
    • Exertional Syncope: A 10 year Retrospective Review

      Pitt, Taylor; The University of Arizona College of Medicine - Phoenix; Cohen, Mitchell (The University of Arizona., 2018-04-06)
      Although the usual faint is common, syncope may be an indication of a more serious underlying condition. Exertional syncope has loosely been defined as syncope occurring during or immediately after activity. The evaluation of exertional syncope is often extensive in order to rule-out a potentially life-threatening conditions. This was a retrospective review of all children presenting to the ambulatory clinics at Phoenix Children’s Hospital over the last 10 years with a syncopal event. This study sought to analyze the most consistent diagnosis for a primary complaint of exertional syncope and the most effective diagnostic tests to rule out serious conditions. Major findings include 1) 25% of patients presenting with exertional syncope were diagnosed with cardiac disease and 2) the association between heart disease and abnormal ECG and heart disease and abnormal electrophysiology (EP) study were both statistically significant with increased Odds Ratios (ORs). Consistent with prior studies, ECG and EP study are appropriate initial tests.
    • Geographic correlation between nonmedical exemption rates in Arizona kindergarten classes and rates of community pertussis infection

      Sun, Sophie; The University of Arizona College of Medicine - Phoenix; Villarroel, Lisa (The University of Arizona., 2018-04-09)
      Background: Every state in the US mandates specific vaccinations for all children prior to school entry. However, many states, such as Arizona, are permit nonmedical exemptions (NMEs), and thus, communities with high levels of NMEs are potentially more vulnerable to outbreaks of vaccine preventable diseases. Objective: The objective of this study was to detect spatial clusters of pertussis cases and kindergarten NMEs of DTaP vaccine in Arizona. Methods: Data detailing kindergarten NMEs for each AZ school in the 2012-13 and 2013-14 school years and pertussis cases with report dates during those time periods were obtained from the Arizona Department of Health Services databases. Addresses for each school and pertussis case were geocoded, and the coordinates were obtained for each corresponding census tract. Using a purely spatial analysis with Poisson probability model, areas with high rates of pertussis or NMEs were identified with SaTScan. Clusters for both the number of NMEs and pertussis cases were detected and presented in maps. Extremely large (>50km radius) clusters extending beyond state boundaries were considered irrelevant and removed. Results: Multiple clusters of NMEs and pertussis cases were identified in two school years. While the clusters were generally in highly populated regions, they were not located at the same region in both years. The NME clusters and case clusters did not always overlap. Conclusions: The current analysis does not support an association between kindergarten NME frequency and pertussis outbreaks within these time periods. Clusters of both NMEs and pertussis cases were located in different regions each year. Since kindergarten NMEs vary from year to year, it is possible that these NME rates are not reflective of those in the community. Further studies with larger datasets will be important in elucidating the spatial distribution of pertussis cases and NMEs.
    • Human Plant Exposures Reported to a Regional (Southwestern) Poison Control Center over Eight Years

      Enfield, David; The University of Arizona College of Medicine - Phoenix; Brooks, Daniel (The University of Arizona., 2018-02-26)
    • Impact of a Smartphone-delivered Sedentary Behavior Intervention on Glucose Metabolism in Prediabetic Adults

      Hicks, Meghan; The University of Arizona College of Medicine - Phoenix; Buman, Matthew (The University of Arizona., 2018-02-26)
      This study investigates whether an 8-week lifestyle-based, smartphone-delivered intervention targeting reduction in sedentary behavior (i.e., sitting) significantly reduces objectively measured time spent sitting and improves fasting glucose and insulin. The incidence of type II diabetes has continued to increase in the United States and increases in sedentary behavior along with reductions in physical activity throughout the day have contributed to the increase of disease. There were 31 participants in the study and they started with a 3-week run-in period where a basic self- monitoring component was installed on their smartphone. After this run-in period, participants were randomly assigned to one of the eight experimental conditions. All participants received a basic self-monitoring with feedback component where they self-reported sleep, sedentary, and more active behaviors. Sitting time was measured with the activPAL3c, which is a device that they wore 24/7. Study visits occurred at week 0 (immediately after the 3-week run-in period), week 4, and week 8. Fasting glucose and insulin were measured at each of these visits. Participants logged approximately 60% of their sleep, sedentary, and exercise behaviors, which took 3– 4 min/day to complete. The impact of the intervention was not significant, such that decreases in sedentary time in those assigned to the sedentary component did not significantly differ from those not assigned to the sedentary component at 8 weeks (beta (SE) = -1.19 (.32), p>0.05); however, the effect size was moderate (Cohen’s d = 0.29). There was no significant impact on fasting glucose or insulin.
    • Is Fever a Marker of Infection or Side Effect of Misoprostol?

      Edinoff, Amber; The University of Arizona College of Medicine - Phoenix; Coonrod, Dean (The University of Arizona., 2018-02-26)
      Introduction: Endometritis, a polymicrobial infection resulting from ascending cervicovaginal bacteria into the uterus, complicates 6-27% of cesarean deliveries. A recent meta-analysis showed a reduction in endometritis in women who received 30 seconds of vaginal cleansing (4.5% vs 8.8%). Our study will look at the rates of endometritis from two time periods – prior to and after the implementation of vaginal cleansing at time of cesarean delivery. We will also investigate the influence of misoprostol on the clinical diagnosis of post-cesarean endometritis.
    • Lestaurtinib (CEP-701) Potentiates the Anticonvulsant Effect of Phenobarbital against Kainic Acid-induced Status Epilepticus

      Kuk, Raafat; The University of Arizona College of Medicine - Phoenix; Obeid, Makram (The University of Arizona., 2018-02-26)
      Status epileptics (SE) can be refractory to standard anti-seizure medications in up to 20% of patients. The timely abortion of SE is key to preventing harmful consequences. Prolonged SE is molecularly characterized by acute alterations in certain ion channels including a decrease in the inhibitory properties and internalization of the γ-Aminobutyric acid type A receptors (GABARs). This increases excitability and weakens the effectiveness of many standard medications such as phenobarbital; the anticonvulsant effect of which is mediated via the modulation of such channels. We have recently shown that blockade of tropomyosin-related kinase B receptor (TrkB) with the investigational new drug, lestaurtinib (CEP-701), attenuates SE-induced hyperexcitability 1. Since TrkB is a regulator of GABARs 2, and its blockade might potentially prevent SE-induced changes in these receptors, we hypothesized that TrkB blockade with CEP-701 will potentiate the anticonvulsant effect of phenobarbital against kainic acid (KA)-induced SE. Seizures were induced in periadolescent postnatal day 35-40 (P35-P40) Sprague Dawley rats by injecting 0.5 μg of KA into the basolateral amygdala. Status epilepticus was confirmed using epidural cortical electroencephalography (EEG). Fifteen minutes after SE onset, rats received either 25 mg/kg of CEP (KA-CEP) or its vehicle (KA-V) intraperitoneally (i.p.). Six hours after SE onset, rats were given 100 mg/kg of phenobarbital i.p., supplemented every 15 minutes with an additional 25 mg/kg until cessation of clinical and electrographic seizures was achieved. All the rats that received KA developed electroclinical SE within 30 minutes to 1 hour after KA injections. The average cumulative dose of phenobarbital required to achieve seizure cessation in the KA-CEP group (107.5 ± 4.5 mg/kg, n=14) was significantly lower than in the KA-V group (125.0 ± 5.4 mg/kg, n=15, t-test, p=0.015). Moreover, recurrence of SE occurred 5-10 hours after abortive therapy in 4 of the KA-V rats, and only in 2 of the KA-CEP rats. Given its known clinical safety profile in children, CEP-701 is a clinically promising adjuvant drug that can be potentially used with standard anticonvulsant medications to abort SE.
    • Low Field-Of-View CT in the Evaluation of Acute Appendicitis in the Pediatric Population

      Feller, Fionna; The University of Arizona College of Medicine - Phoenix; Roh, Albert; Connell, Mary (The University of Arizona., 2018-03-30)
      CT abdomen and pelvis is a widely-used imaging modality used in the evaluation of appendicitis but it carries risks of radiation. A recent retrospective review localizes all appendices (both normal and abnormal) below the level of the L1 vertebral body, obviating the need to scan superior to that level. This study is a retrospective review of prospectively-collected data from 171 consecutive pediatric patients presenting with clinical suspicion of acute appendicitis and undergoing “low FOV CT.” The low FOV CT uses the L1 vertebral body as the superior aspect of the exam instead of the of the dome of the diaphragm as in standard CT.
    • The Mild Cognitive Impairment of Primary Progressive Aphasia: A Case Series

      Lendrum, James; The University of Arizona College of Medicine - Phoenix; Sabbagh, Marwan (The University of Arizona., 2018-04-05)
      The early and mild phases, termed mild cognitive impairment (MCI), of primary progressive aphasia (PPA) have been poorly described. This cross-sectional care series was conducted via retrospective chart review in order to further delineate the MCI stage during progression to PPA. Nine cases of PPA with a secondary diagnosis of MCI were found, all of which had language as the primary domain affected. The most common deficits found were word finding difficulty (8 of 9 cases) and sentence repetition impairments (8 of 8 cases). Our results showed that there is an MCI stage of PPA, characterized by word finding difficulty on observation and sentence repetition on neurocognitive testing. Early mild cognitive impairment for PPA will have language as the primary domain affected either with or without an amnestic component.
    • Misoprostol for the Prevention of Postpartum Hemorrhage and Reduction of Maternal Mortality During Home Birth Deliveries in Developing Countries

      Townley, Kateland; The University of Arizona College of Medicine - Phoenix; Beyda, David (The University of Arizona., 2018-02-28)
      Research conducted in low resource environments suggests misoprostol is effective in reducing the incidence of postpartum hemorrhage (PPH), but larger studies in skilled healthcare facilities suggests misoprostol does not positively impact maternal mortality. There are no systematic reviews specifically examining the effect of misoprostol vs. placebo on PPH in environments where oxytocin is simply not available.
    • Non-Communicable Disease (NCD) Rates in Urbanized versus Rural Populations in Developing Countries.

      Alam, Now Behar; The University of Arizona College of Medicine - Phoenix; Conklin, Cody (The University of Arizona., 2018-03-28)
      Background: Studies estimating the current prevalence rates and future demographics of being overweight or obese and non-communicable diseases initially demonstrated Western countries had the highest rates of obesity. Now, obesity is more prevalent in urban populations of Africa, Central and South America, Asia, and Caribbean and Pacific Islands. Objective: Determine if any differences exist with the NCD rates in urbanized versus rural populations in developing countries. Methods: Using PubMed, a thorough review of the literature was conducted using various search terms related to the research topic. Results: To assess for differences between the urban and rural populations, the effect size using Cohen’s d was utilized to measure the size of associations or differences. Conclusion: Cross-sectional and observational studies comparing BMI values, blood pressure levels, cholesterol levels, and blood glucose levels have addressed if living in urban versus rural areas increases the prevalence of NCDs related to these variables. Urban populations and living a sedentary lifestyle does increase the likelihood of being overweight or obese, hypertension, hypercholesterolemia, but not diabetes.
    • Novel Approach to Determine the Effect of Sub-Optimal Semen Analysis Parameters on Obtaining Euploid Blastocysts after Intracytoplasmic Sperm Injection

      Savage, Narry; The University of Arizona College of Medicine - Phoenix; Lipskind, Shane (The University of Arizona., 2018-04-09)
      Preimplantation genetic screening (PGS) is a method of screening a blastocyst for chromosomal abnormalities during in vitro fertilization (IVF) by performing a karyotype on a single cell from the blastocyst. PGS was previously offered to couples with advanced maternal age, recurrent pregnancy loss, repeated implantation failure, or severe male factor infertility. Now PGS is common practice for all IVF cycles to improve outcomes by selecting chromosomally normal (euploid) embryos for transfer. This investigation aims to study the effect of male semen parameters on the likelihood of obtaining chromosomally normal embryos using ICSI. A unique approach was taken by comparing the outcomes between multiple “paired couples” who have utilized donor eggs obtained from the same donor in the same cycle. This model was adopted to minimize oocyte variation as a confounding variable. Using retrospective record review and data analysis, the relationship between optimal vs suboptimal sperm parameters and the resultant percentage of euploid embryos obtained after ICSI was evaluated.
    • Outcome of Cervical Cerclage in Twin Pregnancies for Treatment of Ultrasound Detected Short Cervix

      Hermann, Catherine; The University of Arizona College of Medicine - Phoenix; Elliott, John (The University of Arizona., 2018-02-26)
      Introduction: The use of cervical cerclage in twin pregnancies is a controversial topic in Obstetrics and Gynecology. It’s use is currently not recommended due to no perceived benefit and potential harm, however recent studies indicate that cerclage may be beneficial.Conclusion: The use of cerclage in twin pregnancies complicated by a TVUS cervical length of 2.0 cm or less prolonged the latency period between diagnosis of short cervix and delivery by 31 days. This data is consistent with other retrospective reviews and indicates the need for a multicenter, prospective randomized control trial.
    • Outcomes for the Hybrid Approach to First State Treatment of Hypoplastic Left Heart Syndrome

      Crawford, Daniel; The University of Arizona College of Medicine - Phoenix; Graziano, Joseph (The University of Arizona., 2018-06-05)
      BACKGROUND & SIGNIFICANCE Hypoplastic left heart syndrome (HLHS) is a congenital condition that involves hypoplasia or atresia of left heart structures. Treatment requires three separate interventions, and the “hybrid” procedure is a less invasive alternative to the initial open-heart operation. This approach has become favorable for certain patients in recent years, but there is a need to better understand the outcomes and the factors that influence the outcomes for hybrid Stage 1 palliation of HLHS.
    • Predicting Diameter of ACL Quadrupled Hamstring Autograft in a Pediatric Population

      Rohrback, Mitchell; The University of Arizona College of Medicine - Phoenix; Vaughn, Jeffrey (The University of Arizona., 2018-04-06)
      Background: The incidence of anterior cruciate ligament tears and subsequent reconstructions in the pediatric population has significantly increased over the last twenty years.2 Hamstring autograft reconstruction is a common approach to ACL reconstruction in the pediatric population because of their open physes and the reduced risk of re-tear with the use of autograft as opposed to allograft tissue.4 In recent publications, the size of the autograft has also been shown to be a significant factor influencing the risk of re-tear after ACL reconstruction with autograft.10 We attempted to determine patient specific factors that would allow us to estimate the patient’s probable quadrupled hamstring graft diameter preoperatively. Characteristics that we evaluated included age, sex, height, weight, BMI, and graft diameter determined intraoperatively. Conclusions: ACL hamstring autograft diameter in a pediatric population can most accurately be predicted using the patient’s height. These results are valuable in determining the treatment plan for children undergoing ACL reconstruction, and provide useful insight for counseling families prior to ACL reconstruction.