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Accuracy Of Neutrophil To Lymphocyte Ratio And Platelet To Lymphocyte Ratio As A Marker For Gastrointestinal Malignancies
Title
The Accuracy Of Neutrophil To Lymphocyte Ratio And Platelet To Lymphocyte Ratio As A Marker For Gastrointestinal Malignancies.
Creator
Nora, Ian, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description
Background: Accurate predictors of locally advanced and recurrence disease in patients with gastrointestinal cancer are currently lacking. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have emerged as possible markers for predicting recurrence in these patients. In this study, we sought to evaluate the utility of NLR and PLR in predicting the presence of regional nodal disease, metastasis and systemic recurrence in patients with gastrointestinal malignancies....
Show moreBackground: Accurate predictors of locally advanced and recurrence disease in patients with gastrointestinal cancer are currently lacking. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have emerged as possible markers for predicting recurrence in these patients. In this study, we sought to evaluate the utility of NLR and PLR in predicting the presence of regional nodal disease, metastasis and systemic recurrence in patients with gastrointestinal malignancies. Methods: We queried a comprehensive gastrointestinal oncology database to identify patients who had undergone surgery for a GI malignancy. NLR and PLR values were determined via a complete blood count (CBC). In patients treated with neoadjuvant therapy (NT) the NLR and PLR were calculated from CBCs before and after NT and in patients proceeding to surgery within 2 weeks pre-operatively. The associations between NLR and PLR and the clinicopathologic parameters (sex, age, tumor size, differentiation, positive lymph nodes, and metastatic disease) were assessed via chi(2) or Fisher's exact tests where appropriate. All the tests were two-sided, and P<0.05 was considered statistically significant. Results: We identified 116 patients diagnosed with gastrointestinal malignancies. There were 76 (65.5%) males and 40 (34.5%) females with an average age of 69.4 +/- 10.7 years. The mean follow up was 14.1 +/- 15.5 months. We identified 49 (42.2%) esophageal, 34 (29.3%) pancreatic, 14 (12.1%) colorectal, 13 (11.2%) gastric, and 6 (5.2%) biliary cancers. There were 36 (31.0%) patients with node negative disease, 52 (44.8%) with node positive and 28 (24.2%) with metastatic disease at surgery. Of the metastatic patients 4 (3.4%) were found at staging laparoscopy and 24 (20.6%) were diagnosed pre-operatively. The median NLR for LN-patient's was 1.78 (0.23-8.2) and for LN+ and metastatic patients was 4.69 (2.27-36), P<0.001. The median PLR for LN-patient's was 123.03 (14-257.69) and for LN+ and metastatic patients was 212.42 (105.45-2,185.18), P<0.001. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for a NLR >2.25 was 98.8%, 72.2%, 89%, and 96% respectively. The sensitivity, specificity, PPV, and NPV for PLR >140 was 95%, 78%, 90%, and 88% respectively. Utilizing both NLR and PLR the sensitivity, specificity, PPV and NPV was increased. Conclusions: Elevation of NLR and PLR can be used to help identify patients with advanced disease GI malignancies and recurrences after surgery. Additionally, failure of normalization of NLR and PLR 3-month post-surgical resection may indicate early recurrence or persistent disease. Individually, NLR has a higher sensitivity and negative predictive value while PLR has a higher specificity and positive predictive value for distinguishing metastatic disease and node positivity. The combination of NLR and PLR has the highest accuracy of predicting advanced disease among all gastrointestinal malignancies.
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Date Issued
2018-10-01
Identifier
FSU_libsubv1_wos_000445720200026, 10.21037/jgo.2018.08.05
Format
Citation
Achalasia
Title
Achalasia.
Creator
Oviedo, Rodolfo J., Sofiak, Chase W., Dixon, Bruce M.
Abstract/Description
INTRODUCTION: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. PRESENTATION OF CASE: Achalasia is typically a...
Show moreINTRODUCTION: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. PRESENTATION OF CASE: Achalasia is typically a disease that affects non-obese adults over the age of 55, which makes the discussion of this case report unique in that our patient is a 23 year-old woman who successfully underwent per-oral endoscopic myotomy (POEM) in preparation for a future laparoscopic sleeve gastrectomy. There is sparse literature on combining laparoscopic Heller myotomy (LHM) and partial fundoplication versus POEM with either restrictive or malabsorptive minimally invasive bariatric procedures. DISCUSSION: LHM and partial fundoplication have long been considered the gold standard surgical treatment for achalasia by disrupting both the longitudinal and circular muscle layers of the LES. The newer, less invasive, POEM technique will be compared to the gold standard LHM and Dor fundoplication in this uncharacteristically young morbidly obese achalasia patient. The decision to pursue a laparoscopic sleeve gastrectomy over a laparoscopic Roux-en-Y gastric bypass was multifactorial due to the patient's concerns regarding malabsorption of vitamins and nutrients in the event of a future pregnancy. CONCLUSION: The patient has already undergone a POEM procedure, which was chosen to maintain the gastric fundus, cardia, and gastroesophageal junction (GEJ) architecture as opposed to a LHM with Dor fundoplication, which would have altered the anatomy, thus making a concomitant laparoscopic sleeve gastrectomy an unfeasible option. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
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Date Issued
2016
Identifier
FSU_libsubv1_wos_000384278500002, 10.1016/j.ijscr.2016.06.046
Format
Citation
Achalasia
Title
Achalasia: A case report on its effect during surgical decision making for laparoscopic sleeve gastrectomy in the young morbidly obese patient..
Creator
Oviedo, Rodolfo J, Sofiak, Chase W, Dixon, Bruce M
Abstract/Description
Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. Achalasia is typically a disease that affects non-obese adults...
Show moreAchalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. Achalasia is typically a disease that affects non-obese adults over the age of 55, which makes the discussion of this case report unique in that our patient is a 23 year-old woman who successfully underwent per-oral endoscopic myotomy (POEM) in preparation for a future laparoscopic sleeve gastrectomy. There is sparse literature on combining laparoscopic Heller myotomy (LHM) and partial fundoplication versus POEM with either restrictive or malabsorptive minimally invasive bariatric procedures. LHM and partial fundoplication have long been considered the gold standard surgical treatment for achalasia by disrupting both the longitudinal and circular muscle layers of the LES. The newer, less invasive, POEM technique will be compared to the gold standard LHM and Dor fundoplication in this uncharacteristically young morbidly obese achalasia patient. The decision to pursue a laparoscopic sleeve gastrectomy over a laparoscopic Roux-en-Y gastric bypass was multifactorial due to the patient's concerns regarding malabsorption of vitamins and nutrients in the event of a future pregnancy. The patient has already undergone a POEM procedure, which was chosen to maintain the gastric fundus, cardia, and gastroesophageal junction (GEJ) architecture as opposed to a LHM with Dor fundoplication, which would have altered the anatomy, thus making a concomitant laparoscopic sleeve gastrectomy an unfeasible option.
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Date Issued
2016-01-01
Identifier
FSU_pmch_27423062, 10.1016/j.ijscr.2016.06.046, PMC4949807, 27423062, 27423062, S2210-2612(16)30230-9
Format
Citation
AKT expression is associated with degree of pathologic response in adenocarcinoma of the esophagus treated with neoadjuvant therapy.
Title
AKT expression is associated with degree of pathologic response in adenocarcinoma of the esophagus treated with neoadjuvant therapy.
Creator
Saeed, Nadia, Shridhar, Ravi, Hoffe, Sarah, Almhanna, Khaldoun, Meredith, Kenneth L
Abstract/Description
Neoadjuvant chemoradiation (NCRT) has become standard in the treatment of locally advanced esophageal adenocarcinoma (EAC) with survival correlated to degree of pathologic response. The phosphatidyl inositol 3 kinase (PI3K)/protein kinase B (AKT)/mTOR pathway plays an important role in tumorgenesis and resistance. We sought to elucidate the role of this pathway in patients with EAC who received NCRT. After IRB approval, a prospective trial was initiated in which patients with EAC underwent...
Show moreNeoadjuvant chemoradiation (NCRT) has become standard in the treatment of locally advanced esophageal adenocarcinoma (EAC) with survival correlated to degree of pathologic response. The phosphatidyl inositol 3 kinase (PI3K)/protein kinase B (AKT)/mTOR pathway plays an important role in tumorgenesis and resistance. We sought to elucidate the role of this pathway in patients with EAC who received NCRT. After IRB approval, a prospective trial was initiated in which patients with EAC underwent endoscopic biopsies of normal and tumor tissue prior to instituting NCRT. Patients then proceeded to esophagectomy. The pre-treatment tissues underwent gene expression profiling. SAM method was used to analyze expression of AKT within normal and tumor tissue. Expression was then correlated to degree of pathologic response. One-hundred patients were consented for the study, of which 67 met final eligibility. Nineteen patient's tumors ultimately underwent gene expression profiling via microarray. The differential expression of all AKT isoforms in tumor tissue was markedly overexpressed compared to normal tissue (P=6×10(-5)). There were 3 patients designated as pNR, 6 as pPR, and 10 as pCR. Partial and non-responders had higher expressions of AKT compared to pCR with the non-responders consistently illustrated the highest expression of AKT (P=0.02). There was a significant correlation between individual isoforms of AKT-1, AKT-2, and AKT-3 and degree of pathologic response (P=0.002, 0.04, and 0.04 respectively). AKT is overexpressed in patients with AC of the esophagus. Moreover, pathologic response to NCRT may be correlated with degree of AKT expression. Additional data is needed to clarify this relationship to potentially add targeted therapies to the neoadjuvant regimen.
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Date Issued
2016-04-01
Identifier
FSU_pmch_27034781, 10.3978/j.issn.2078-6891.2015.067, PMC4783740, 27034781, 27034781, jgo-07-02-158
Format
Citation
Callosal Apraxia
Title
Callosal Apraxia: A 34-year Follow-up Study.
Creator
Falchook, Adam D., Watson, Robert T., Heilman, Kenneth M.
Abstract/Description
Loss of ability of the left upper limb (LUL) to correctly produce spatial and temporal components of skilled purposeful movements was reported 34years ago in a woman with a callosal infarction. To learn about recovery, we recently reexamined this woman. This woman was tested for ideomotor apraxia by asking her to pantomime to command and to seeing pictures of tools. Whereas she performed normally with her right upper limb, her LUL remained severely apraxic, making many spatial (postural and...
Show moreLoss of ability of the left upper limb (LUL) to correctly produce spatial and temporal components of skilled purposeful movements was reported 34years ago in a woman with a callosal infarction. To learn about recovery, we recently reexamined this woman. This woman was tested for ideomotor apraxia by asking her to pantomime to command and to seeing pictures of tools. Whereas she performed normally with her right upper limb, her LUL remained severely apraxic, making many spatial (postural and movement) errors. Initially, she did not reveal loss of finger-hand deftness (limb-kinetic apraxia), and when tested again with the coin rotation task, her left hand performance was normal. Without vision, she could name objects placed in her left hand but not name numbers written in this hand. Since this woman had a callosal lesion, failure to recover cannot be accounted for by left hemisphere inhibition of her right hemisphere. Although failure for her LUL to improve may have been related to not using her LUL for skilled actions, her right hemisphere was able to observe transitive actions, and this failure of her LUL to produce skilled purposeful movements suggests her right hemisphere may have not had the capacity to learn these movement representations. Without vision, her ability to recognize objects with her left hand, but not numbers written on her left palm, suggests graphesthesia may require that her left hand did not have access to movement representations important for programming these numbers when writing.
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Date Issued
2016-06
Identifier
FSU_libsubv1_wos_000379936800011, 10.1080/13554794.2016.1148743
Format
Citation
Caring for Older Adults with the Human Immunodeficiency Virus
Title
Caring for Older Adults with the Human Immunodeficiency Virus.
Creator
Sangarlangkarn, Aroonsiri, Appelbaum, Jonathan S
Abstract/Description
Increasing proportions of older adults are living with the human immunodeficiency virus (HIV). It is estimated that more than 50% of individuals with HIV in the United States are aged 50 and older. Part of this group consists of individuals who have aged with chronic HIV infection, but a large proportion also results from new HIV diagnosis, with approximately 17% of new HIV diagnoses in 2013 occurring in individuals aged 50 and older. Although many of the recommendations on management of HIV...
Show moreIncreasing proportions of older adults are living with the human immunodeficiency virus (HIV). It is estimated that more than 50% of individuals with HIV in the United States are aged 50 and older. Part of this group consists of individuals who have aged with chronic HIV infection, but a large proportion also results from new HIV diagnosis, with approximately 17% of new HIV diagnoses in 2013 occurring in individuals aged 50 and older. Although many of the recommendations on management of HIV infection are not age-specific, individuals with HIV aged 50 and older differ from their younger counterparts in many aspects, including immune response to antiretroviral therapy, multimorbidity, antiretroviral toxicities, and diagnostic considerations. This article outline these differences, offers a strategy on how to care for this unique population, and provides special considerations for problem-based management of individuals with HIV aged 50 and older.
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Date Issued
2016-09-29
Identifier
FSU_libsubv1_scholarship_submission_1483969272, 10.1111/jgs.14584
Format
Citation
Clinical Fate Of T0n1 Esophageal Cancer
Title
Clinical Fate Of T0n1 Esophageal Cancer: Results From The National Cancer Database.
Creator
Takahashi, Caitlin, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description
The long-term survival for patients with locally advanced esophageal cancer (EC) remains poor despite improvements in multi-modality care. Neoadjuvant chemoradiation (NCR) followed by surgical resection remains pivotal in the management of patients with EC. However, the outcome of patients whose primary tumor exhibits a complete response with residual regional nodal disease (T0N1) remains unclear as well as the role for adjuvant therapy. Utilizing the National Cancer Database we identified...
Show moreThe long-term survival for patients with locally advanced esophageal cancer (EC) remains poor despite improvements in multi-modality care. Neoadjuvant chemoradiation (NCR) followed by surgical resection remains pivotal in the management of patients with EC. However, the outcome of patients whose primary tumor exhibits a complete response with residual regional nodal disease (T0N1) remains unclear as well as the role for adjuvant therapy. Utilizing the National Cancer Database we identified patients with EC who underwent NCR followed by esophagectomy who had subsequent pathology of T0N1. Baseline univariate comparisons of patient characteristics were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests as appropriate. Pearson's Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method comparing survival curves with the log-rank test. All statistical tests were two-sided and alpha (type I) error <0.05 was considered statistically significant. We identified 7,116 patients diagnosed with EC; 6,235 (87.6%) adenocarcinoma (AC), 881 (12.4%) squamous cell carcinoma (SCC) with a median age of 62 [21-88] years. There were 6,031 (84.8%) males and 1,085 (15.2%) females. R0 resections were achieved in 6,668 (93.7%) patients and this correlated to improved median survival 39.5 (R0) and 20.1 (R1) months respectively, P<0.001. The median nodes harvested were 13 [0-83] with a mean positive LN's of 1.4 +/- 2.9. Pathologic complete response (pCR) was achieved in 1,334 (18.7%), partial response (pPR) 2,812 (39.5%) and non-response (pNR) 2,970 (41.7%). There were 230 (3.2%) patients deemed as pathologic T0N1. The median survival of patients with pCR was 61.7 months compared to 32.1 months in the T0N1 patients P<0.001. T0N1 patients did not demonstrate an improved survival over T1/2 patients who had a median survival of 30.5 months, P=0.79. However, T0N1 did reveal an improved survival over T3/4 patients who had a median survival of 24.6 months, P=0.02. Adjuvant chemotherapy in T0N1 did not provide a benefit in survival, median survival adjuvant versus no adjuvant 30.8 vs. 32.1 months respectively, P=0.08. Multivariate analysis in T0N1 patients demonstrated only number of LN's positive, and histology SCC vs. ACC as predictive of survival, HR, 1.22, 95% CI: 1.10-1.36, P<0.001; HR, 0.43, 95% CI: 0.24-0.75, P=0.003, respectively. Patients with EC who exhibit a pathologic T0N1 after NCR have oncologic fates similar to node positive patients. Patients with pCR of the primary tumor and regional lymph nodes continue to demonstrate significant survival benefits over all remaining pathologic cohorts.
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Date Issued
2018-10-01
Identifier
FSU_libsubv1_wos_000445720200016, 10.21037/jgo.2018.08.08
Format
Citation
Combined DSEK and Transconjunctival Pars Plana Vitrectomy
Title
Combined DSEK and Transconjunctival Pars Plana Vitrectomy.
Creator
Sane, Mona, Shaikh, Naazli, Shaikh, Saad
Abstract/Description
We report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for...
Show moreWe report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for rapid anatomical recovery and return of function and visual acuity in a single sitting.
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Date Issued
2016
Identifier
FSU_libsubv1_wos_000378284400001, 10.1155/2016/9728035
Format
Citation
Combined DSEK and Transconjunctival Pars Plana Vitrectomy.
Title
Combined DSEK and Transconjunctival Pars Plana Vitrectomy.
Creator
Sane, Mona, Shaikh, Naazli, Shaikh, Saad
Abstract/Description
We report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for...
Show moreWe report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for rapid anatomical recovery and return of function and visual acuity in a single sitting.
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Date Issued
2016-01-01
Identifier
FSU_pmch_27413563, 10.1155/2016/9728035, PMC4927958, 27413563, 27413563
Format
Citation
Correlation Of Tumor Size And Survival In Pancreatic Cancer
Title
Correlation Of Tumor Size And Survival In Pancreatic Cancer.
Creator
Takahashi, Caitlin, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description
Background: Neoadjuvant therapy (NT) for resectable pancreatic adenocarcinoma (PAC) continues to be debated. We sought to establish the relationship between pancreatic tumor size, neoadjuvant chemotherapy (NCT), neoadjuvant chemoradiation (NCRT), and definitive surgery (DS) on survival. Methods: Utilizing the National Cancer Database we identified patients with PAC who underwent NT and DS. Patient characteristics and survival were compared with Mann-Whitney U, Pearson's Chi-square, and the...
Show moreBackground: Neoadjuvant therapy (NT) for resectable pancreatic adenocarcinoma (PAC) continues to be debated. We sought to establish the relationship between pancreatic tumor size, neoadjuvant chemotherapy (NCT), neoadjuvant chemoradiation (NCRT), and definitive surgery (DS) on survival. Methods: Utilizing the National Cancer Database we identified patients with PAC who underwent NT and DS. Patient characteristics and survival were compared with Mann-Whitney U, Pearson's Chi-square, and the Kaplan-Meier method. Multivariable analysis (MVA) was developed to identify predictors of survival. All tests were two-sided and a <0.05 was significant. Results: We identified 11,707 patients: 9,722 patients with tumors >2 cm and 1,985 with tumors =2 cm. There were 523 patients treated with NCT, 559 treated with NCRT, and 10,625 DS. Patients with tumors >2 cm were more likely to have higher T-stage, P<0.001, positive lymph nodes, P<0.001, poor histologic grade, P<0.001, and R1 resections, P<0.001. The median survival for patients with tumors =2 cm was 30.6 months compared to 20.5 months for those whose tumors were >2 cm, P<0.001. In the >2 cm groups the median survival for NCT, NCRT, and DS was 22.9, 25.8 and 21.3 months, P=0.01. MVA revealed that age, Charlson/Deyo score, N-stage, grade, tumor size >2 cm, R0 resection, and NT were predictors of survival. Ninety-day mortality was worse in both the NCT and NCRT compared to DS, P<0.001. Conclusions: The size of pancreatic cancer correlates to pathologic stage and overall survival. Tumors >2 and <2 cm benefited from a NT. However, the 90-operative mortality was significantly worse in those patients receiving NT.
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Date Issued
2018-10-01
Identifier
FSU_libsubv1_wos_000445720200020, 10.21037/jgo.2018.08.06
Format
Citation
Early goal-directed therapy in severe sepsis and septic shock
Title
Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE.
Creator
Nguyen, H. Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W., Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill...
Show moreNguyen, H. Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W., Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill, Jasreen Kaur, Gardner-Gray, Jayna, Pflaum, Jacqueline, Domecq, Juan Pablo, Hurst, Gina, Belsky, Justin B., Fowkes, Raymond, Elkin, Ronald B., Simpson, Steven Q., Falk, Jay L., Singer, Daniel J., Rivers, Emanuel P.
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Abstract/Description
Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar...
Show morePrior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was largely incorporated into the first 6 hours of sepsis management (resuscitation bundle) adopted by the Surviving Sepsis Campaign and disseminated internationally as the standard of care for early sepsis management. Recently a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate interpretation of these trials and their conclusions.
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Date Issued
2016-07-01
Identifier
FSU_libsubv1_wos_000379790100001, 10.1186/s13054-016-1288-3
Format
Citation
Early goal-directed therapy in severe sepsis and septic shock
Title
Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE..
Creator
Nguyen, H Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W, Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill,...
Show moreNguyen, H Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W, Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill, Jasreen Kaur, Gardner-Gray, Jayna, Pflaum, Jacqueline, Domecq, Juan Pablo, Hurst, Gina, Belsky, Justin B, Fowkes, Raymond, Elkin, Ronald B, Simpson, Steven Q, Falk, Jay L, Singer, Daniel J, Rivers, Emanuel P
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Abstract/Description
Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar...
Show morePrior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was largely incorporated into the first 6 hours of sepsis management (resuscitation bundle) adopted by the Surviving Sepsis Campaign and disseminated internationally as the standard of care for early sepsis management. Recently a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate interpretation of these trials and their conclusions.
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Date Issued
2016-07-01
Identifier
FSU_pmch_27364620, 10.1186/s13054-016-1288-3, PMC4929762, 27364620, 27364620, 10.1186/s13054-016-1288-3
Format
Citation
Eczema's Big Break In Hollywood
Title
Eczema's Big Break In Hollywood.
Creator
Om, Amit
Date Issued
2018-02
Identifier
FSU_libsubv1_wos_000425134900029
Format
Citation
Emergency total proctocolectomy in an uninsured patient with Familial Adenomatous Polyposis Syndrome and acute lower gastrointestinal hemorrhage in a community hospital
Title
Emergency total proctocolectomy in an uninsured patient with Familial Adenomatous Polyposis Syndrome and acute lower gastrointestinal hemorrhage in a community hospital.
Creator
Oviedo, Rodolfo J., Dixon, Bruce M., Sofiak, Chase W.
Abstract/Description
INTRODUCTION: Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. PRESENTATION OF CASE: A 41-year-old...
Show moreINTRODUCTION: Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. PRESENTATION OF CASE: A 41-year-old uninsured African American man with no past medical or family history presented to the emergency department with hematochezia lasting three days. A clinical diagnosis of FAP made on colonoscopy with biopsies revealed villous and tubulovillous adenomas without dysplasia. After blood products resuscitation, an emergency total proctocolectomy with end ileostomy was performed. A staged ileal J pouch to anal anastomosis and creation of protective loop ileostomy was performed months later after securing state funding. A final loop ileostomy reversal occurred six weeks later. His self reported quality of life is improved. DISCUSSION: Lower GI hemorrhage from FAP unresponsive to blood products may require emergency total proctocolectomy and end ileostomy with a staged ileal J pouch to anal anastomosis, which can be done in a community acute care hospital for an uninsured patient. CONCLUSION: A total proctocolectomy is feasible in the emergency setting in an uninsured patient with lower GI bleeding and FAP. A staged ileal J pouch-anal anastomosis is easier to justify to the hospital compared to a staged completion colectomy with proctectomy. It is essential to monitor the ileo-anal anastomosis with anoscopy. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
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Date Issued
2016
Identifier
FSU_libsubv1_wos_000384278500045, 10.1016/j.ijscr.2016.07.052
Format
Citation
Emergency total proctocolectomy in an uninsured patient with Familial Adenomatous Polyposis Syndrome and acute lower gastrointestinal hemorrhage in a community hospital
Title
Emergency total proctocolectomy in an uninsured patient with Familial Adenomatous Polyposis Syndrome and acute lower gastrointestinal hemorrhage in a community hospital: A case report..
Creator
Oviedo, Rodolfo J, Dixon, Bruce M, Sofiak, Chase W
Abstract/Description
Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. A 41-year-old uninsured African American man with no past...
Show moreRectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. A 41-year-old uninsured African American man with no past medical or family history presented to the emergency department with hematochezia lasting three days. A clinical diagnosis of FAP made on colonoscopy with biopsies revealed villous and tubulovillous adenomas without dysplasia. After blood products resuscitation, an emergency total proctocolectomy with end ileostomy was performed. A staged ileal J pouch to anal anastomosis and creation of protective loop ileostomy was performed months later after securing state funding. A final loop ileostomy reversal occurred six weeks later. His self reported quality of life is improved. Lower GI hemorrhage from FAP unresponsive to blood products may require emergency total proctocolectomy and end ileostomy with a staged ileal J pouch to anal anastomosis, which can be done in a community acute care hospital for an uninsured patient. A total proctocolectomy is feasible in the emergency setting in an uninsured patient with lower GI bleeding and FAP. A staged ileal J pouch-anal anastomosis is easier to justify to the hospital compared to a staged completion colectomy with proctectomy. It is essential to monitor the ileo-anal anastomosis with anoscopy.
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Date Issued
2016-01-01
Identifier
FSU_pmch_27497040, 10.1016/j.ijscr.2016.07.052, PMC4976607, 27497040, 27497040, S2210-2612(16)30290-5
Format
Citation
Endonasal (Closed) Rhinoplasty Technique Securing Spreader Grafts With Barbed Suture
Title
Endonasal (Closed) Rhinoplasty Technique Securing Spreader Grafts With Barbed Suture.
Creator
Bradford, Benjamin D., Asher, Scott A., Ardeshirpour, Farhad
Date Issued
2016-10
Identifier
FSU_libsubv1_wos_000384295300015, 10.1001/jamafacial.2016.0294
Format
Citation
Esophagectomy From Then To Now
Title
Esophagectomy From Then To Now.
Creator
Takahashi, Caitlin, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description
We have come a long way from the onset of surgery for esophageal cancer. Surgical resection is pivotal for the long-term survival in patients with locally advanced esophageal cancer. Moreover, advancements in post-operative care and surgical techniques have contributed to reductions in morbidity. More recently minimally invasive esophagectomy has been increasingly used in patients undergoing esophageal cancer resection. Potential advantages of MIE include: the decreased pulmonary...
Show moreWe have come a long way from the onset of surgery for esophageal cancer. Surgical resection is pivotal for the long-term survival in patients with locally advanced esophageal cancer. Moreover, advancements in post-operative care and surgical techniques have contributed to reductions in morbidity. More recently minimally invasive esophagectomy has been increasingly used in patients undergoing esophageal cancer resection. Potential advantages of MIE include: the decreased pulmonary complications, lower post-operative wound infection, decreased post-operative pain, and decreased length of hospitalization. The application of robotics to esophageal surgery is becoming more widespread. Robotic esophageal surgery has potential advantages over the known limitations of laparoscopic and thoracoscopic approaches to esophagectomy while adhering to the benefits of the minimally invasive approach. This paper is a review of the evolution from open esophagectomy to the most recent robotic approach.
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Date Issued
2018-10-01
Identifier
FSU_libsubv1_wos_000445720200019, 10.21037/jgo.2018.08.15
Format
Citation
Extracranial Metastatic Burden In Extensive-stage Small Cell Lung Cancer
Title
Extracranial Metastatic Burden In Extensive-stage Small Cell Lung Cancer: Implications For Prophylactic Cranial Irradiation.
Creator
Oliver, Daniel E., Donnelly, Olivia G., Grass, G. Daniel, Naghavi, Arash O., Yang, George Q., Dilling, Thomas J., Perez, Bradford A.
Abstract/Description
Background: Patients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI. Methods: We retrospectively reviewed 173 patients with ES-SCLC treated between 2010-2015. Of these, 117 patients were initially diagnosed without brain metastases and...
Show moreBackground: Patients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI. Methods: We retrospectively reviewed 173 patients with ES-SCLC treated between 2010-2015. Of these, 117 patients were initially diagnosed without brain metastases and received systemic chemotherapy. Following exclusion of patients who received PCI and less than 2 cycles of platinum doublet therapy, 93 patients remained. Patient records were reviewed for clinical and radiographic features previously identified as relevant risk factors. Primary outcome was brain metastasis-free survival (BMFS). Kaplan-Meier analysis, log-rank tests and Cox multivariate models were used to compare outcomes. Results: Median follow-up was 10.7 months (range, 3-58 months). Thirty-eight (40.9%) patients developed brain metastases. Three or more metastatic sites was associated with inferior BMFS on univariable (1-year estimate 43.8% vs. 61.3%; P=0.020) and multivariable (MVA) analysis (hazard ratio (HR) 2.33, 95% CI: 1.08-5.01; P=0.03). Conclusions: Our results suggest that extracranial metastatic burden is associated with an increased risk for brain metastases in patients with ES-SCLC. As there is no clear standard regarding delivery of PCI in this patient population, utilizing the number of metastatic disease sites as a clinical indicator may help to improve selection of patients who benefit from PCI.
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Date Issued
2018-07-01
Identifier
FSU_libsubv1_wos_000440380200071, 10.21037/jtd.2018.06.92
Format
Citation
Implementation of the Ten Steps to Successful Breastfeeding Saves Lives
Title
Implementation of the Ten Steps to Successful Breastfeeding Saves Lives.
Creator
Meek, Joan Younger, Noble, Lawrence
Date Issued
2016-10
Identifier
FSU_libsubv1_wos_000385643000005, 10.1001/jamapediatrics.2016.2015
Format
Citation
Implementation Planning Of A Mhealth Vaccination Tool
Title
Implementation Planning Of A Mhealth Vaccination Tool: A Workflow Study In Four Pediatric Clinics.
Creator
Staras, Stephanie, Rich, Natalie, Samarah, Esaa, Thompson, Lindsay, Muszynski, Michael, Shenkman, Elizabeth
Date Issued
2018-03-28
Identifier
FSU_libsubv1_wos_000428652000056
Format
Citation
Improving Adolescent Health Risk Assessment
Title
Improving Adolescent Health Risk Assessment: A Multi-method Pilot Study..
Creator
Thompson, Lindsay A, Wegman, Martin, Muller, Keith, Eddleton, Katie Z, Muszynski, Michael, Rathore, Mobeen, De Leon, Jessica, Shenkman, Elizabeth A
Abstract/Description
Objectives Given poor compliance by providers with adolescent health risk assessment (HRA) in primary care, we describe the development and feasibility of using a health information technology (HIT)-enhanced HRA to improve the frequency of HRAs in diverse clinical settings, asking adolescents' recall of quality of care as a primary outcome. Methods We conducted focus groups and surveys with key stakeholders (Phase I) , including adolescents, clinic staff and providers to design and implement...
Show moreObjectives Given poor compliance by providers with adolescent health risk assessment (HRA) in primary care, we describe the development and feasibility of using a health information technology (HIT)-enhanced HRA to improve the frequency of HRAs in diverse clinical settings, asking adolescents' recall of quality of care as a primary outcome. Methods We conducted focus groups and surveys with key stakeholders (Phase I) , including adolescents, clinic staff and providers to design and implement an intervention in a practice-based research network delivering private, comprehensive HRAs via tablet (Phase II). Providers and adolescents received geo-coded community resources according to individualized risks. Following the point-of-care implementation , we collected patient-reported outcomes using post-visit quality surveys (Phase III). Patient-reported outcomes from intervention and comparison clinics were analyzed using a mixed-model, fitted separately for each survey domain. Results Stakeholders agreed upon an HIT-enhanced HRA (Phase I). Twenty-two academic and community practices in north-central Florida then recruited 609 diverse adolescents (14-18 years) during primary care visits over 6 months; (mean patients enrolled = 28; median = 20; range 1-116; Phase II). Adolescents receiving the intervention later reported higher receipt of confidential/private care and counseling related to emotions and relationships (adjusted scores 0.42 vs 0.08 out of 1.0, p < .01; 0.85 vs 0.57, p < .001, respectively, Phase III) than those receiving usual care. Both are important quality indicators for adolescent well-child visits. Conclusions Stakeholder input was critical to the acceptability of the HIT-enhanced HRA. Patient recruitment data indicate that the intervention was feasible in a variety of clinical settings and the pilot evaluation data indicate that the intervention may improve adolescents' perceptions of high quality care.
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Date Issued
2016-12-01
Identifier
FSU_pmch_27406154, 10.1007/s10995-016-2070-5, PMC5124035, 27406154, 27406154, 10.1007/s10995-016-2070-5
Format
Citation
Intravitreal Injection-Induced Migraine Headaches.
Title
Intravitreal Injection-Induced Migraine Headaches.
Creator
Lerebours, Valerie C, Nguyen, Thanh-Giao, Sarup, Vimal, Rossi, Fabian, Shaikh, Saad
Abstract/Description
A case of migraine headache triggered by intravitreal injection, and aborted by retrobulbar injection, is reported. To date, migraine and related cephalgia have not been reported after intravitreal injection. Ophthalmologists and neurologists should be aware of this potential sequela of a very common procedure.
Date Issued
2016-04-06
Identifier
FSU_pmch_27190726, 10.7759/cureus.561, PMC4859816, 27190726, 27190726
Format
Citation
Malignant Peritoneal Mesothelioma Presenting As Mucinous Ascites
Title
Malignant Peritoneal Mesothelioma Presenting As Mucinous Ascites.
Creator
Field, Zachary, Zori, Andreas, Khullar, Vikas, Mota, Manoela, Feely, Michael, Firpi, Roberto J.
Abstract/Description
We present a rare case of a 46-year-old man presenting with mucinous ascites secondary to malignant peritoneal mesothelioma (MPM) that was diagnosed via colonoscopy with biopsies. Both our findings and the clinical presentation were unique. While it is widely known that asbestos exposure is commonly associated with pleural mesothelioma, 6-10% of malignant mesotheliomas arise from the peritoneum. To date, only 4 cases of MPM with the primary tumor site in the colon have been described in the...
Show moreWe present a rare case of a 46-year-old man presenting with mucinous ascites secondary to malignant peritoneal mesothelioma (MPM) that was diagnosed via colonoscopy with biopsies. Both our findings and the clinical presentation were unique. While it is widely known that asbestos exposure is commonly associated with pleural mesothelioma, 6-10% of malignant mesotheliomas arise from the peritoneum. To date, only 4 cases of MPM with the primary tumor site in the colon have been described in the literature.
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Date Issued
2018-03-14
Identifier
FSU_libsubv1_wos_000427466000004, 10.14309/crj.2018.23
Format
Citation
Medical Concerns in HIV-Positive Aging
Title
Medical Concerns in HIV-Positive Aging.
Creator
Simone, Mark, Appelbaum, Jonathan
Abstract/Description
The management and prognosis of HIV disease has changed dramatically since the introduction of combination HIV antiretroviral therapy in 1996. Thus, the number of older adults with HIV is increasing partly because people with HIV are living longer. At the same time, the rates of new HIV cases in older adults (usually defined as people over the age of 50) are also increasing. Currently, about 25 percent of all patients living with HIV are older than 50, and by 2015 adults older than 50 will...
Show moreThe management and prognosis of HIV disease has changed dramatically since the introduction of combination HIV antiretroviral therapy in 1996. Thus, the number of older adults with HIV is increasing partly because people with HIV are living longer. At the same time, the rates of new HIV cases in older adults (usually defined as people over the age of 50) are also increasing. Currently, about 25 percent of all patients living with HIV are older than 50, and by 2015 adults older than 50 will account for 50 percent of the population living with HIV.1 These trends make understanding the medical challenges of HIV in older adults more important than ever. This article reviews the special issues associated with HIV and AIDS in an older population.
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Date Issued
2009
Identifier
FSU_migr_clinicalsciences_faculty_publications-0001
Format
Citation
Optimal unified combination rule in application of Dempster-Shafer theory to lung cancer radiotherapy dose response outcome analysis
Title
Optimal Unified Combination Rule In Application Of Dempster-shafer Theory To Lung Cancer Radiotherapy Dose Response Outcome Analysis.
Creator
He, Yanyan, Hussaini, M. Yousuff, Gong, Yutao U. T., Xiao, Ying
Abstract/Description
Our previous study demonstrated the application of the Dempster-Shafer theory of evidence to dose/volume/outcome data analysis. Specifically, it provided Yager's rule to fuse data from different institutions pertaining to radiotherapy pneumonitis versus mean lung dose. The present work is a follow-on study that employs the optimal unified combination rule, which optimizes data similarity among independent sources. Specifically, we construct belief and plausibility functions on the lung cancer...
Show moreOur previous study demonstrated the application of the Dempster-Shafer theory of evidence to dose/volume/outcome data analysis. Specifically, it provided Yager's rule to fuse data from different institutions pertaining to radiotherapy pneumonitis versus mean lung dose. The present work is a follow-on study that employs the optimal unified combination rule, which optimizes data similarity among independent sources. Specifically, we construct belief and plausibility functions on the lung cancer radiotherapy dose outcome datasets, and then apply the optimal unified combination rule to obtain combined belief and plausibility, which bound the probabilities of pneumonitis incidence. To estimate the incidence of pneumonitis at any value of mean lung dose, we use the Lyman-Kutcher-Burman (LKB) model to fit the combined belief and plausibility curves. The results show that the optimal unified combination rule yields a narrower uncertainty range (as represented by the belief-plausibility range) than Yager's rule, which is also theoretically proven.
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Date Issued
2016
Identifier
FSU_libsubv1_wos_000368341200002, 10.1120/jacmp.v17i1.5737
Format
Citation
Outcomes Associated With Robotic Approach To Pancreatic Resections
Title
Outcomes Associated With Robotic Approach To Pancreatic Resections.
Creator
Takahashi, Caitlin, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description
Minimally invasive techniques have improved post-operative outcomes, however, the majority of pancreatic surgery, known for its complexity, is still performed via open approaches. The development of robotics has improved dexterity which may allow for application in more complex surgeries. We queried a prospectively maintained robotic database to identify patients who underwent robotic pancreatic resection by a single surgeon between 2012 and 2016. Patient demographics and operative outcomes...
Show moreMinimally invasive techniques have improved post-operative outcomes, however, the majority of pancreatic surgery, known for its complexity, is still performed via open approaches. The development of robotics has improved dexterity which may allow for application in more complex surgeries. We queried a prospectively maintained robotic database to identify patients who underwent robotic pancreatic resection by a single surgeon between 2012 and 2016. Patient demographics and operative outcomes were compared using Mann-Whitney U, Kruskal Wallis and Pearson's Chi-square test as appropriate. We identified 119 patients; 65 Whipples [Robotic Whipple (RW)], 43 distal pancreatectomies, 4 total pancreatectomies, 6 pancreatic enucleations, and 1 robotic cyst gastrostomy with a median age of 71 [24-91], median body mass index (BMI) of 27.6 (16.8-40.2), and American society of anesthesiologists (ASA) of 3. The median estimated blood loss (EBL) was 125 [25-800] and loss of heterozygosity (LOH) 6 [1-34]. Mean operative time for RW decreased after 15 cases (578 vs. 457 minutes, P<0.004). Conversions to open occurred in 5 (4.2%) patients. In total of 117 (98.3%) patients underwent R0 resections and the median lymph node (LN) harvest was 16 [0-37]. The 30 and 90 days mortality was 1 (0.8%). Major complications (Clavien-Dindo grade 3-5) were seen in 16 (13.4%) cases (20.3%) but decreased steadily as volume increased (case 30). Pancreatic leaks occurred in 14 (11.8%): A, 8 (6.7%); B, 4 (3.4%); and C, 2 (1.7%). Robotic assisted approaches to pancreatic resections is feasible. However, it takes approximately 15 cases before a decrease in operative time and 30 cases before major complications are decreased. These trends in complications are associated with surgeon experience and volume are critical to consider in robotic pancreatic surgery.
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Date Issued
2018-10-01
Identifier
FSU_libsubv1_wos_000445720200022, 10.21037/jgo.2018.08.04
Format
Citation
Peculiar Adenocarcinoma
Title
A Peculiar Adenocarcinoma.
Creator
Patel, Ameet, Patel, Anjan
Date Issued
2018-05-01
Identifier
FSU_libsubv1_wos_000431868700024, 10.1001/jamaoncol.2017.3989
Format
Citation
Psychometric analysis of the Systematic Observation of Red Flags for autism spectrum disorder in toddlers.
Title
Psychometric analysis of the Systematic Observation of Red Flags for autism spectrum disorder in toddlers.
Creator
Dow, Deanna, Guthrie, Whitney, Stronach, Sheri T, Wetherby, Amy M
Abstract/Description
The purpose of this study was to examine the utility of the Systematic Observation of Red Flags as an observational level-two screening measure to detect risk for autism spectrum disorder in toddlers when used with a video-recorded administration of the Communication and Symbolic Behavior Scales. Psychometric properties of the Systematic Observation of Red Flags were examined in a sample of 247 toddlers of 16- to 24 months old: 130 with autism spectrum disorder, 61 with developmental delays,...
Show moreThe purpose of this study was to examine the utility of the Systematic Observation of Red Flags as an observational level-two screening measure to detect risk for autism spectrum disorder in toddlers when used with a video-recorded administration of the Communication and Symbolic Behavior Scales. Psychometric properties of the Systematic Observation of Red Flags were examined in a sample of 247 toddlers of 16- to 24 months old: 130 with autism spectrum disorder, 61 with developmental delays, and 56 typically developing. Individual items were examined for performance to create an algorithm with improved sensitivity and specificity, yielding a total Composite score and Domain scores for Social Communication and Restricted Repetitive Behaviors. Codes indicating clear symptom presence were collapsed to yield a count of the number of Red Flags for the overall scale and each symptom domain. Results indicated significant group differences with large effects for the Composite, both Domain scores, and Red Flags score, and good discrimination (area under the curve = 0.84-0.87) between autism spectrum disorder and nonspectrum groups for the Composite, Social Communication Domain, and Social Communication Red Flags score. The Systematic Observation of Red Flags provides an observational screening measure for 16- to 24-month-olds with good discrimination, sensitivity, and specificity. A cutoff of 20 on the Composite is recommended to optimally detect autism spectrum disorder risk.
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Date Issued
2017-04-01
Identifier
FSU_pmch_27132013, 10.1177/1362361316636760, PMC5734914, 27132013, 27132013, 1362361316636760
Format
Citation
Retinopathy and Uveitis Associated with Sofosbuvir Therapy for Chronic Hepatitis C Infection.
Title
Retinopathy and Uveitis Associated with Sofosbuvir Therapy for Chronic Hepatitis C Infection.
Creator
Chin-Loy, Katrina, Galaydh, Farah, Shaikh, Saad
Abstract/Description
We report a case of retinopathy and uveitis associated with sofosbuvir therapy for hepatitis C infection. Case report. A 57-year-old-male developed ocular inflammation and retinopathy four weeks after the administration of sofosbuvir for a hepatitis C infection. Hearing loss, rheumatologic disease, and essential tremor were also noted. The ophthalmic findings resolved with discontinuation of the drug.     The authors report a case of sofosbuvir induced retinopathy and uveitis, the first...
Show moreWe report a case of retinopathy and uveitis associated with sofosbuvir therapy for hepatitis C infection. Case report. A 57-year-old-male developed ocular inflammation and retinopathy four weeks after the administration of sofosbuvir for a hepatitis C infection. Hearing loss, rheumatologic disease, and essential tremor were also noted. The ophthalmic findings resolved with discontinuation of the drug.     The authors report a case of sofosbuvir induced retinopathy and uveitis, the first associated with this emerging therapy for hepatitis C. Ophthalmologists and other treating physicians should be aware of the ophthalmic side effects of this drug.
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Date Issued
2016-05-03
Identifier
FSU_pmch_27335709, 10.7759/cureus.597, PMC4895080, 27335709, 27335709
Format
Citation
Small caliber covered self-expanding metal stents in the management of malignant dysphagia.
Title
Small caliber covered self-expanding metal stents in the management of malignant dysphagia.
Creator
Kucera, Stephen, Barthel, James, Klapman, Jason, Shridhar, Ravi, Hoffe, Sarah, Harris, Cynthia, Almhanna, Khaldoun, Meredith, Kenneth
Abstract/Description
Use of large caliber [≥18 mm body diameter (BD)] self-expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with BDs between 10-16 mm in malignant dysphagia. Thirty-one patients underwent direct endoscopic placement of 50 sccSEMS between January 2008 and March 2011. Patients were...
Show moreUse of large caliber [≥18 mm body diameter (BD)] self-expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with BDs between 10-16 mm in malignant dysphagia. Thirty-one patients underwent direct endoscopic placement of 50 sccSEMS between January 2008 and March 2011. Patients were monitored for change in dysphagia score (DS), stent migration, AEs, and death through May 2011. DS improved in 30 of 31 patients (97%). The median DS decreased from 3 to 2 (P<0.0001). The median effective duration of first sccSEMS placement was 116 (95% CI: 75-196) days. Major and minor AE rates were 6.5% and 19.4% respectively. No stent related deaths were encountered. The overall migration rate was 36% (18/50). The anticipated migration rate was 45.7% (16/35) and the unanticipated migration rate was 13.3% (2/15) (P=0.052). Positive effective clinical outcome occurred in 93.5% (29/31) of cases. In malignant dysphagia, direct endoscopic sccSEMS placement provided acceptable dysphagia control and migration rates with substantial reductions in stent related AEs and MRs compared to those reported for large caliber SEMS.
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Date Issued
2016-06-01
Identifier
FSU_pmch_27284474, 10.21037/jgo.2015.12.03, PMC4880758, 27284474, 27284474, jgo-07-03-411
Format
Citation
Unexpected Stealing From the Heart.
Title
Unexpected Stealing From the Heart.
Creator
Jones-Ince, Ingrid, Todd, Gregory
Abstract/Description
Coronary subclavian steal syndrome (CSSS) is defined as retrograde flow in the internal mammary artery graft, after coronary artery bypass surgery, resulting in anterior wall myocardial ischemia. If undiagnosed, it may lead to significant infarction. Its incidence has been under-reported. A 74-year-old woman presented with sudden onset of typical angina, which was associated with dyspnea, nausea, and vomiting. Her medical history was significant for coronary artery disease, with prior...
Show moreCoronary subclavian steal syndrome (CSSS) is defined as retrograde flow in the internal mammary artery graft, after coronary artery bypass surgery, resulting in anterior wall myocardial ischemia. If undiagnosed, it may lead to significant infarction. Its incidence has been under-reported. A 74-year-old woman presented with sudden onset of typical angina, which was associated with dyspnea, nausea, and vomiting. Her medical history was significant for coronary artery disease, with prior coronary artery bypass surgery (CABG), chronic obstructive pulmonary disease (COPD), hypertension, diabetes type 2, dyslipidemia, hypothyroidism, and depression. Physical examination demonstrated a weak left radial pulse, and a differential blood pressure reading in her arms. She developed massive hematochezia that resulted in electrocardiogram changes: ST segment depression in the inferior and lateral leads with isolated ST segment elevation of aVR. Cardiac catheterization demonstrated retrograde flow through the left internal mammary artery (LIMA), resulting in CSSS. This case highlights the diagnostic challenge of CSSS as the underlying etiology for ischemia in a patient with remote coronary artery bypass surgery (CABG). It underscores the importance of thorough physical examination in patients who are at high risk for coronary atherosclerosis and remote complications after CABG. It also highlights optimal strategies for management of CSSS with percutaneous transluminal angioplasty.
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Date Issued
2016-03-21
Identifier
FSU_pmch_26996774, PMC4805133, 26996774, 26996774, 895498
Format
Citation
Use of Gabapentin in the Treatment of Neurogenic Cough
Title
The Use of Gabapentin in the Treatment of Neurogenic Cough: A Case Report and Review.
Creator
del Calvo, Veronica, Lackey, Alexandra, Li, John
Abstract/Description
Cough is one of the most common chief complaints presenting for medical evaluation. While the diagnoses of URI, postnasal drip, asthma, and gastroesophageal reflux (GERD) are easily made and easily treated, there are many cases that remain difficult to diagnose and treat. This study highlights a difficult case of intractable cough, and its resolution. The objective of this study is to draw attention to the diagnosis of Sensory neuropathic cough and update the diagnostician with an expanded...
Show moreCough is one of the most common chief complaints presenting for medical evaluation. While the diagnoses of URI, postnasal drip, asthma, and gastroesophageal reflux (GERD) are easily made and easily treated, there are many cases that remain difficult to diagnose and treat. This study highlights a difficult case of intractable cough, and its resolution. The objective of this study is to draw attention to the diagnosis of Sensory neuropathic cough and update the diagnostician with an expanded armamentarium of tools for treatment of the difficult cough patient. Sensory neuropathic cough (SNC) is a commonly overlooked diagnosis that can be successfully treated with Gabapentin class medications.
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Date Issued
2018-03-14
Identifier
FSU_libsubv1_scholarship_submission_1521314352_73ff5557, 10.19080/GJO.2018.13.555869
Format
Citation