Faculty Scholarship

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September 2020

  1. Garrigos, Z.E., Almeida, N.E.C., Gurram, P., Vijayvargiya, P., Campioli, C.G.C., Stulak, J.M., Rizza, S.A., Baddour, L.M., and Sohail, M. R. (2020). Management and outcome of left ventricular assist device infections in patients undergoing cardiac transplantation. Open Forum Infectious Diseases, 7(8), 1-8. https://doi.org/10.1093/ofid/ofaa303

Patients with left ventricular assist device (LVAD)-specific infection were managed with median of 14 days of antibiotics after heart transplantation with no relapses. For cases of uncomplicated LVAD-related blood-stream infection (BSI), who completed therapy pre-transplant, antibiotics were discontinued after standard peri-operative prophylaxis and none experienced recurrence.

  1. Shane, A.L., Sato, A. I., Kao, C., Adler-Shohet, F.C., Vora, S.B., Auletta, J.A., Nachman, S., Raabe, V.N., Inagaki, K., Akinboyo, I.C., Woods, C., Alsulami, A.O., Kainth, M.K., Santos, R.P., Espinosa, C.M., Burns, J.E., Cunningham, C.K., Dominguez, S.R., Martinez, B.L., Zhu, F., Crews, J., Kitano, T., Saiman, L., Kotloff, K., A Pediatric Infectious Disease Perspective of SARS-CoV-2 and COVID-19 in Children. Journal of the Pediatric Infectious Diseases Society, piaa099, https://doi.org/10.1093/jpids/piaa099

Understanding the role that children play in the clinical burden and propagation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for novel coronavirus (COVID-19) infections is emerging. While the severe manifestations and acute clinical burden of COVID-19 has largely spared children compared to adults, understanding the epidemiology, clinical presentation, diagnostics, management, and prevention opportunities as well as the social and behavioral impacts on child health is vital. Foremost is clarifying the contribution of asymptomatic and mild infections to transmission within the household and community and the clinical and epidemiologic significance of uncommon severe post-infectious complications. Herein we summarize the current knowledge, identify useful resources, and outline research opportunities. Pediatric infectious disease clinicians have a unique opportunity to advocate for the inclusion of children in epidemiological, clinical, treatment and prevention studies to optimize their care, as well as to represent children in the development of guidance and policy during pandemic response.

  1. Shipley, S.R., Clarks, M.S., and Norris, D.R. (2020). The suicidal patient. In: Paulman, P., Taylor, R., Paulman, A., Nasir L. (eds). Family Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0779-3_34-2

Suicide is the intentional ending of one’s own life that is oftentimes the end result of another pathologic process such as substance abuse, mood disorders, or psychosis. Suicidality itself may be divided into a continuum of seriousness ranging from thoughts of death to passive and then active suicidal ideations which include a plan to suicide attempts and finally to completed suicide (Krug et al., World report on violence and health, vol 1.World Health Organization, Geneva, 2002). A related though somewhat separate entity is chronic suicidality often seen in the context of personality disorders (Wortzel et al., J Psychiatr Pract 20:63–67, 2014).

  1. Simock, R., Thomas, T.V.,Estes, C., Fillippi, A.R., Katz, M.A., Pereira, I.J., Saeed, H. COVID-19: Global radiation oncology's targeted response for pandemic preparedness. Clinical and Translational Radiation Oncology. 2020 Mar 24;22:55-68. doi: https://doi:10.1016/j.ctro.2020.03.009.  PMID: 32274425. 

As the global COVID-19 pandemic escalates there is a need within radiation oncology to work to support our patients in the best way possible. Measures are required to reduce infection spread between patients and within the workforce. Departments need contingency planning to create capacity and continue essential treatments despite a reduced workforce. The radiation oncology community held an urgent online journal club in March 2020 to discuss these issues and create some consensus on urgent next steps. There were 121 global contributors. This document summarizes these discussions around themes of infection prevention, rationalization of workload and working practice in the presence of infection

  1. Thomas, T.V.,Packianathan, S., Ahmed, H.Z., Joseph, S., Bhanat, E., Mundra, E.K., Kuruvilla, T.P., Vijayakumar, S. The Role of Concurrent Chemoradiotherapy and SBRT for Palliation of Previously Untreated Head and Neck Cancers. Precision Radiation Oncology. 2020 Mar 5. https://doi.org/10.1002/pro6.1086

Palliative concurrent chemoradiotherapy has not been evaluated well for patients who are not a candidate for definitive treatment. Even though stereotactic radiotherapy had established a role in the reirradiation of recurrent head and neck tumors, its role is not established as a possible primary treatment modality in patients who are not eligible for curative treatment. This article reviews the available literature on the role of chemoradiotherapy and stereotactic radiation for palliation of previously untreated head and neck cancers.

  1. Thomas, T.V.,Packianathan, S., Bhanat, E., Albert, A., Abraham, A., Gordy, X.Z., Kanakamedala, M.R., Mehta, D., Vijayakumar, S. Oligometastatic Head and Neck Cancer: A Comprehensive Review. Journal of the Sciences and Specialties of the Head and Neck.  2020 Mar 27. PMID: 32220043 https://doi.org/10.1002/hed.26144

There are limited data available regarding the management of oligometastatic squamous cell carcinoma of the head and neck (SCCHN) patients, and no consensus guidelines are available. The objective is to review the available literature for the management of oligometastatic SCCHN. Articles were selected from English Medline literature between 1995 and 2018, searched by using the keywords: oligometastatic SCCHN/metastasectomy/ stereotactic body radiation treatment. With the available data, oligometastatic SCCHN patients appear to behave differently and tend to have a better prognosis than those with widespread metastases. Retrospective evidence suggests that the aggressive treatment of the primary disease and local treatment of the metastatic sites improves survival in oligometastatic SCCHN at diagnosis. The definitive treatment of the distant metastatic sites using metastasectomy or SBRT correlates with better survival in oligorecurrent patients. we concluded that Oligometastatic SCCHN patients may have a better prognosis if treated aggressively.

  1. Thomas, T.V,Kuruvilla, T.P., Kahn, J., Bhanat, E., Parr, A.Q., Albert, A.A., Chowdhary, M/, Beriwal, S., Vijayakumar, S. Variations in Resources among Radiation Oncology Residency Programs in the United States. Advances in Radiation Oncology, 2020, ISSN 2452-1094, https://doi.org/10.1016/j.adro.2020.08.001.

The purpose of this research was to assess the existing variations in the residency training resources among radiation oncology (RO) residency programs in the United States. A total of 94 radiation oncology residency programs were identified during the academic year 2018-2019 and data were collected. The median number of attending physicians was 13 (Range: 4 -71). The median number of physicists and biologists were 9 and 3, respectively. The conventional techniques, including 3DCRT, IMRT, Electron Therapy, and SBRT/SRS, are available in all residency programs. In terms of specialized EBRT machines, Gamma knife, CyberKnife, and MRI LINAC were available in 49 (52%), 21(22%), and 7 (8%) programs, respectively. Only 19 programs (20%) had in house proton therapy availability; however, 37 programs (39%) offered proton therapy training via resident rotation at an affiliated institution. Prostate, gynecologic, and breast brachytherapy were available in 81 (86%), 82 (87%), and 58 (62%) of programs, respectively. Eighty-one (86%) programs reported to have High Dose Rate (HDR), and only 20 (21%) programs have Low Dose Rate (LDR) brachytherapy. Our study found that marked variations exist among RO residency programs in the United States with regards to the number of faculty and treatment machines or modalities. This study reports the status of these variations during the academic year 2018-2019 and will serve as a baseline for future intervention.

  1. Thomas, T.V, Kuruvilla, T.P., Holliday, E.B., Bhanat, E., Parr, A.Q., Albert, A.A., Page, B., Schuster, J., Chapman, C., Vijayakumar, S. Cross-sectional Gender Analysis of US Radiation Oncology Residency Programs in 2019: More Than a Pipeline Issue? Advances in Radiation Oncology, 2020, ISSN 2452-1094, https://doi.org/10.1016/j.adro.2020.07.008.

The purpose of this study is to assess the current status of gender disparities in academic radiation oncology departments in the United States and the associated factors. Women constituted 30.8% of radiation oncology residents in the United States in 2019. Eight programs (12.5%) did not have any female residents in their programs, whereas six programs (9%) had women constituting more than half of their resident class. The fraction of female medical students applying to radiation oncology over the last seven years varied between 27% and 33%. Female attending physicians accounted for 30.5% of all the attending physicians in the academic programs. In the leadership positions of the department, the gender gap was wider where only 19 (20%), and 11 (12%) of programs had female program director or chair, respectively. There was a positive correlation between the number of attending physicians and the number of female residents in programs (p=0.01). A significant gender disparity continues to exist among the residents and physicians in the academic Radiation Oncology departments in the U.S. This disparity is pronounced in the leadership positions. The results of this study could be used as a benchmark to evaluate the progress that had been made by the efforts to improve gender disparities in radiation oncology.

  1. Thomas, T.V., Kuruvilla, T.P., Bhanat, E., Parr, A.Q., Albert, A.A., Vijayakumar, S. An analysis of the resident’s research, education, and wellness resources in radiation oncology residency programs in the United States. Advances in Radiation Oncology, 2020, ISSN 2452-1094, https://doi.org/10.1016/j.adro.2020.08.005.

The purpose of this research is to evaluate the variations in research, education, and wellness resources for residents among Radiation Oncology (RO) residency programs across the United States. Information from the 94 ACGME accredited RO residency programs during the academic year 2018-2019 was collected. Seventy-five (80%) programs have reported the duration of dedicated research time on their websites. At least six months were allowed in 48 (51%) programs, whereas 27 (29%) programs have reported the dedicated research time is negotiable. Outstandingly, 20 (21%) programs allow one year of dedicated research time, and the median dedicated research time was nine months. From our study, only 13 (14%) residency programs reported to allow residents to rotate in other departments of the same institution. Fifty-nine (63%) programs allow away rotations at other institutions (external electives). An international rotation was permitted only in 19 (20%) programs. Regarding the wellness resources, fatigue management training, resident retreat, and resident mentoring programs were reported to be available in 53%, 26%, and 42% of programs, respectively. The salary information was obtainable for 63 institutions, and the yearly compensation ranged between $51,000 to $78,000. Moonlighting was allowed only in 28 (30%) of programs.Our study found that major variations exist among RO residency programs in the United States regarding research, education, and wellness resources for residents.

  1. Thompson, D.J, Yom, S.S., Saeed, H., Naqa, I.E., Ballas, L., Bentzen, S., Chao, S.T., Choudhury, A., Coles, C.E., Dover, L., Guadagnolo, A., Guckenberger, M., Hoskin, P., Jabbour, S., Katz, M., Mukherjee, S., Rembielak, A., Sebag-Montefiore, D., Sher, D.J., Terezakis, S., Thomas, V., Vogel J, Estes C. Radiation fractionation schedules published during the COVID-19 Pandemic: A systematic review of the quality of evidence and recommendations for future development. International Journal of Radiation Oncology Biology Physics. 2020; 108(2):379-389. doi: 10.1016/j.ijrobp.2020.06.054. PMID: 32798063 

Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19eadapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from estab- lished higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P Z .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these poten- tially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.

August 2020

  1. Busche, K., Elks, M. L., Hanson, J. T., Jackson-Williams, L., Manuel, R. S., Parsons, W. L., Wofsy, D., Yuan, K. The Validity of Scores from the New MCAT Exam in Predicting Student Perforamnce: Results from a Multisite Study. Academic Medicine. 95(3): 387-395, March 2020.

  2. Garg, T., Desai, A., Gala, K., Warawdekar, G., Tavri, S., (2020) Interventional Radiology Preparedness During Coronavirus Disease (COVID-19) Pandemic. Indian Journal of Radiology and Imaging.

This is a review article about state of affairs of the COVID-19 pandemic in India, and guidelines for IR departments across of the country to prepare adequately for a surge.

  1. Jackson-Williams, L., The University of Mississippi School of Medicine, Academic Medicine, Volume 95, No. 9, September Supplement 2020.

This article provides an overview of the University of Mississippi’s medical education program. It includes key features of the curriculum such as a description of the curriculum, curriculum changes since 2010, pedagogies, and clinical experiences. A snapshot of facts for the School of Medicine is also provided.

  1. Le H., Shue A., Freedman S., The Shrinking Eye: Dimensional Changes in the Young Child’s Eye after Glaucoma Drainage Device Implantation for Refractory Childhood Glaucoma. Journal of AAPOS. 2020 Apr;24(2):84.e1-84.e4. doi: 10.1016/j.jaapos.2019.12.011.  PMID: 32092365.

This study was designed to investigate the magnitude of reduction in the axial length (AL) and corneal diameter following glaucoma drainage device (GDD) placement and intraocular pressure (IOP) reduction in glaucoma patients <3 years of age at surgery. In this study cohort, reduction in AL, corneal diameter, and cup:disk ratio was found to be correlated with reduced IOP after GDD placement. This result merits consideration during surgical planning for glaucoma patients <3 years of age.

  1. Liu, Y., Feng K., Jiang H., Hu F., Gao J., Zhang W., Zhang W., Huang B., Brant R., Zhang C., Yan H., Characteristics and Treatments of Ocular Blast Injury in Tianjin Explosion in China. BMC Ophthalmology. 2020 May 6; 20(1):185. doi: 10.1186/s12886-020-01448-3. PMID: 32375694.  PMCID: PMC7203803.

    Grant Support: (81830026/National Natural Science Foundation of China; 18ZXDBSY00030/Natural Science Foundation of Tianjin)

The study was to investigate the healing process and functional recovery of neuroretina after idiopathic macular hole surgery, as well as analyzing the influencing factors.  Various ocular injuries were commonly in the casualties of blast, in which open-globe injuries have worst visual prognosis. OTS is a valid approach for evaluation of prognosis and optimizing the therapeutic strategies subsequently in the massive casualty. Intense rescue and careful examination, proper surgery should be performed correctly to rescue patients.

  1. McDonald, Tyler C., Drake, Luke C., Replogle, William H., Graves, Matthew L., Brooks, Jaysson T., Barriers to Increasing Diversity in Orthopaedics, JBJS Open Access: April-June 2020 - Volume 5 - Issue 2.
  1. Penman, Alan D., Crowder, Kimberly, Watkins, William, 50 Studies Every Ophthalmologist Should Know. Oxford University press, 2020.

The book, 50 Studies Every Ophthalmologist Should Know, presents key studies that have shaped the practice of ophthalmology. Selected using a rigorous methodology, emphasis has been placed on landmark studies, which have influenced current ophthalmology practice guidelines. For each study, a concise summary is presented with an emphasis on the results and limitations of the study, and its implications for practice. An illustrative clinical case concludes each review, followed by brief information on other relevant studies. This book is a must-read for ophthalmologists, especially those in training or preparing for board review, as well as anyone who wants to learn more about the data behind clinical practice.

This article provides the residency program perspective in an effort to determine what orthopaedic residency program directors and coordinators believe are the barriers to improving diversity at their own programs. The top three barriers to increasing racial/ethnic diversity included: (1) not having enough minority faculty, which may deter minority applicants, (2) consistently high ranking of minority applicants but not matching them, and (3) not enough minority applicants.

  1. Wang T., Li J., Xie R., Want J., Zhang W., Jiang F., Du M., Want X., Huang B., Brant R., Zhang C., Yan H., Intraocular Tumour Necrosis Factor Ligand Related Molecule 1 A Links Disease Progression of Proliferative Diabetic Retinopathy after Primary Vitrectomy. Clinical and Experimental Pharmacology & Physiology. 2020 Jun; 47(6):966-976.  doi: 10.1111/1440-1681.13284.  PMID: 32064668.

    Grant Support: (18ZXDBSY00030/Natural Science Foundation of Tianjin City; 31871184/National Natural Science Foundation of China; 81830026/National Natural Science Foundation of China)

This study aims to examine levels of TL1A in serum and intraocular fluid in patients with proliferative diabetic retinopathy (PDR), and to explore the correlation of intraocular TL1A with the prognosis of PDR progression after primary vitrectomy. Tumour necrosis factor ligand related molecule 1 A (TL1A), a member of tumour necrosis factor superfamily, has been identified as a crucial regulator for vascular homeostasis and inflammation. However, the function of TL1A in diabetic retinopathy (DR) is largely unknown. TL1A and multiple inflammatory cytokines were highly enriched in the intraocular fluid of PDR patients compared with the controls. Lower levels of intraocular TL1A were associated with development of PDR complications after primary PPV and might be used as prognostic factor in predicting the vitrectomy outcome in PDR patients.

  1. Zhang W., Han H., Feng K., Wang X., Du M., Meng X., Liu Y., Huang B., Brant R., Yan H., Is it Necessary to Use Tobramycin-dexamethasone Eye Ointment Prophylactically in Eyes at the End of Intraocular Surgery?. BMC Ophthalmology. 2020 May 27;20(1):208. doi: 10.1186/s12886-020-01476-z. PMID: 32460732. PMCID: PMC7254748.

    Grant Support: (81830026/National Natural Science Foundation of China; 31871184/National Natural Science Foundation of China; 81800815/National Natural Science Foundation of China)

This study aimed to explore the necessity of using ocular tobramycin-dexamethasone prophylactically at the end of intraocular surgery.  We did not observe a statistically significant difference in the incidence of endophthalmitis in patients with or without prophylactic tobramycin-dexamethasone eye ointment. A tobramycin-dexamethasone eye ointment seemed to increase some side effects such as eye secretions increasing and foreign body feeling.

  1. Zhu X., Wang J., Li J., Chen H., Huang B., Yan H., The Healing Process and Functional Recovery of Neuroretina after Idiopathic Macular Hole Surgery without Internal Limiting Membrane Reversal Tamponade. Journal of Ophthalmology. 4 May 2020:2478943. doi: 10.1155/2020/2478943. PMID: 32454986.  PMCID: PMC7222536.

The study was to investigate the healing process and functional recovery of neuroretina after idiopathic macular hole surgery, as well as analyzing the influencing factors. Full-thickness IMHs could achieve anatomic closure 3 to 5 days after surgery with first-step inner retina tissue bridging. Otherwise, they were not able to achieve hole closure and opened to larger holes about two weeks postoperatively. Macular hole diameter was an important factor affecting the healing of the holes. The delayed restoration of fovea detachment and ellipsoid area deficiency were responsible for poor vision outcomes after surgery.