Archive

Main Content

Publications

July 2021

  1. Gaude, E., Nogueira, B., Ladreda Mochales, M., Graham, S., Smith, S., Shaw, L., Graziadio, S., Ladreda Mochales, G., Sloan, P., Bernstock, J.D., Shekhar, S., Gropen, I., Price, C.I.. A Novel Combination of Blood Biomarkers and Clinical Stroke Scales Facilitates Detection of Large Vessel Occlusion Ischemic Strokes. Diagnostics. 2021; 11(7):1137. https://doi.org/10.3390/diagnostics11071137

    Acute ischemic stroke caused by large vessel occlusions (LVOs) is a major contributor to stroke deaths and disabilities; however, identification for emergency treatment is challenging. We recruited two separate cohorts of suspected stroke patients and screened a panel of blood-derived protein biomarkers for LVO detection. Diagnostic performance was estimated by using blood biomarkers in combination with NIHSS-derived stroke severity scales. Multivariable analysis demonstrated that D-dimer (OR 16, 95% CI 5–60; p-value < 0.001) and GFAP (OR 0.002, 95% CI 0–0.68; p-value < 0.05) comprised the optimal panel for LVO detection. Combinations of D-dimer and GFAP with a number of stroke severity scales increased the number of true positives, while reducing false positives due to hemorrhage, as compared to stroke scales alone (p-value < 0.001). A combination of the biomarkers with FAST-ED resulted in the highest accuracy at 95% (95% CI: 87–99%), with sensitivity of 91% (95% CI: 72–99%), and specificity of 96% (95% CI: 90–99%). Diagnostic accuracy was confirmed in an independent cohort, in which accuracy was again shown to be 95% (95% CI: 87–99%), with a sensitivity of 82% (95% CI: 57–96%), and specificity of 98% (95% CI: 92–100%). Accordingly, the combination of D-dimer and GFAP with stroke scales may provide a simple and highly accurate tool for identifying LVO patients, with a potential impact on time to treatment.

  2. Jagtap, R., Garrido, M.B., Hansen, M. Osteopathia striata in the mandible with cranial sclerosis: a case report and review of the literature. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2021 Apr 30; 47(2):141-4.

    The internal carotid artery (ICA) can take multiple pathways as it extends from the carotid bifurcation to the skull base. An aberration of its normal pathway may place the ICA in a retropharyngeal position in close proximity to the posterior pharyngeal wall. Radiographic classification is based on its proximity to the pharynx and/or pathway. We present a series of three cases of retropharyngeal ICAs, our goal is to report and classify these variations.

    Case 1 - Retropharyngeal right ICA. Minimum distance to the pharyngeal wall was ~ 4.9 mm (high risk of vascular injury) with a tortuous pathway.

    Case 2 - Bilateral retropharyngeal ICA. ICAs were in contact with the posterior pharyngeal wall (very high risk of vascular injury). The left has a kinking pathway, the right tortuous.

    Case 3 - Bilateral retropharyngeal ICA. Minimum distances of the right and left ICAs to the posterior pharyngeal wall were ~ 3.5 mm and ~ 3.3 mm, respectively (high risk of vascular injury). The right has a kinking pathway, the left tortuous.

    Closeness of the vessel to the retropharyngeal wall increases the risk of surgical and non-surgical complications. Noteworthy is that the position of the artery is not constant and can change in position over periods of time.

    Conclusion Knowledge of the anatomy and variations of the ICA is important for oral and maxillofacial radiologists and surgeons to enable clinicians to take necessary precautions to decrease complications if performing any procedure in the region.

  3. Jagtap, R., Shuff, N., Bawazir, M., GARRİDO, M.B., Bhattacharyya, I., Hansen, M. A Rare Presentation of Radicular Cyst: A Case Report and Review of Literature. European Annals of Dental Sciences; 48(1).

    The radicular cyst is the most common inflammatory odontogenic cyst in the jaws. It is a periapical lesion associated with non-vital teeth in the tooth-bearing regions of the jaws with a slight male predilection. A radicular cyst is typically asymptomatic, but if large or secondarily infected may cause swelling. The usual radiographic appearance of a radicular cyst is that of a periapical radiolucent lesion. This case report documents a rare case of 61-year-old male with a mixed-density periapical lesion diagnosed as a radicular cyst. The lesion presented as a well defined, expansile, space occupying, corticated, sclerotic, hydraulic, unilocular, mixed density lesion, associated with the right mandibular second premolar that was predominantly radiolucent with scattered foci of radiopacities. Microscopic examination revealed fragments of lining epithelium along with small fragments of inflamed fibrous connective tissue, aggregates of necrotic cellular debris, and bacterial colonies intermixed with foci of dystrophic calcifications. The histopathological diagnosis was a radicular cyst with dystrophic calcification. Although rare, this entity should be considered in the differential diagnosis of mixed-density periapical lesions. Complete history and proper diagnosis is important in this type of rare cases as treatment varies between a radicular cyst and other odontogenic neoplasms.

  4. Vargas-Luna, J.L., Brown, J., Krenn, M.J., McKay, B., Mayr, W., Rothwell, J.C., Dimitrijevic, M.R. (2021). Neurophysiology of epidurally evoked spinal cord reflexes in clinically motor-complete posttraumatic spinal cord injury. Experimental Brain Research. https://doi.org/10.1007/s00221-021-06153-1

    Increased use of epidural Spinal Cord Stimulation (eSCS) for the rehabilitation of spinal cord injury (SCI) has highlighted the need for a greater understanding of the properties of reflex circuits in the isolated spinal cord, particularly in response to repetitive stimulation. Here, we investigate the frequency-dependence of modulation of short- and long-latency EMG responses of lower limb muscles in patients with SCI at rest. Single stimuli could evoke short-latency responses as well as long-latency (likely polysynaptic) responses. The short-latency component was enhanced at low frequencies and declined at higher rates. In all muscles, the effects of eSCS were more complex if polysynaptic activity was elicited, making the motor output become an active process expressed either as suppression, tonic or rhythmical activity. The polysynaptic activity threshold is not constant and might vary with different stimulation frequencies, which speaks for its temporal dependency. Polysynaptic components can be observed as direct responses, neuromodulation of monosynaptic responses or driving the muscle activity by themselves, depending on the frequency level. We suggest that the presence of polysynaptic activity could be a potential predictor for appropriate stimulation conditions. This work studies the complex behaviour of spinal circuits deprived of voluntary motor control from the brain and in the absence of any other inputs. This is done by describing the monosynaptic responses, polysynaptic activity, and its interaction through its input–output interaction with sustain stimulation that, unlike single stimuli used to study the reflex pathway, can strongly influence the interneuron circuitry and reveal a broader spectrum of connectivity.

  5. Williams, M.S., Wells, J., Duhé, R.J., Shirley, T., Lampkin, A., Murphy, M, and Allen, T.C. The College of American Pathologists Foundation's See, Test & Treat Program®: an Evaluation of a One-Day Cancer Screening Program Implemented in Mississippi. Journal of Cancer Education (2021) online ahead of print; PMID: 34164764; DOI: 10.1007/s13187-021-02060-9

    This manuscript describes the implementation and evaluation of the College of American Pathologists Foundation's See, Test & Treat Program®, a cancer screening and education program aimed at increasing access to cancer screening for underserved women in the Jackson Metropolitan Area. Quantitative and qualitative data provide evidence of the impact of this community event on the 103 women who were screened for breast, cervical, and/or oral cancers, including one woman whose follow-up diagnosis confirmed she had stage 4 oral cancer.

June 2021

  1. Wright, C.B., Auchus, A.P., Lerner, A.J., Ambrosius, W.T., Ay, H., Bates, J.H., Chen, J., Meschia, J., Pancholi, S., Papademetriou, V., Rastogi, A., Sweeney, M., Willard, J.J., Yee, J., Oparil, S. Effect of intensive versus standard blood pressure control on stroke subtypes. Hypertension 77:1391-1398, 2021.

    The frequency of stroke subtypes occurring in the intensive BP control versus  standard BP control arms of the SPRINT trial were not statistically different.

May 2021

  1. Agor, A., Ward, K.H.M. Camouflaging techniques for patients with central centrifugal cicatricial alopecia. International Journal of Women's Dermatology. 2021 Mar;7(2):180-183. DOI: 10.1016/j.ijwd.2020.11.003.

    The treatment of central centrifugal cicatricial alopecia in middle-aged and older African-American women is difficult. Thus camouflage is a key approach to managing these patients.

  2. Auchus, A., Brodell, R.T., Nahar, V.K., Ward, K.H.M. Avoiding the Hazards of Ultraviolet Light in the Adolescent Population. SKIN: Journal of Cutaneous Medicine and Surgery, (2020) 4(3): 189-199.

    For many patients, half of their total lifetime ultraviolet light exposure occurs before age 21. Approaches to minimize UV exposure in adolescents are reviewed.

  3. Badon, H.R., Desrosier, A.S., Brodell, R.T., Helms, S.E. Chapter 2: Morphology and Diagnostic Techniques. Dermatologic Manual of Outdoor Hazards. eds. J Trevino and A Chen. 2020: 1-12.

    This book chapter reviews the morphology of insect bite reactions and the bedside tests used to make a definitive diagnosis.

  4. Badon, H., Helms, S.,Flischel, A. (In Press). Chapter 9: Academic rural dermatology offices clinic in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    Academic practice is possible in rural dermatology settings. The approaches to successful academics in rural America are discussed.

  5. Berman, B., Callen, J.P., Brodell, R.T. Preface. The Illustrated History of the American Dermatological Association 1876-2020. The American Dermatological Association, Davie, Florida, 2020.

    This book was written to review the history of the American Dermatological Association and the biographies of all members since 1876. 

  6. Bhate, C., Ho, C., Brodell, R.T. Time to revisit Health Insurance Portability and Accountability Act (HIPPA)? Accelerated telehealth adoption during the COVID-19 Pandemic. Journal of the American Academy of Dermatology.

    The onset of the COVID-19 pandemic necessitated the use of telehealth to care for patients who were largely restricted to their homes.  As the pandemic wanes a careful reassessment of federal rules and regulations is required to protect patients while freeing physicians to care for patients in rural areas, nursing homes, prisons, and other situations where telehealth represents a key approach to providing access to healthcare.

  7. Bhatia, K., Brodell, R.T., Bhatia, A.C., Mockbee, C.S. Interdigital Tinea: The Forerunner of Infectious Eczematoid Dermatitis. (2020) SKIN: Journal of Cutaneous Medicine and Surgery, 4 (4): 353-356.

    A patient with a history of chronic interdigital tinea presented with a severe, edematous, moist, macerate dermatitis over the feet which proved to be an infectious eczematoid dermatitis. The diagnosis, pathophysiology, and treatment of this condition were reviewed.

  8. Boddie, P.P., Desrosiers, A.S., Crabtree, C., Hall, K.D., Brodell, R.T. Preserving wellness in dermatology residents. Clinics in Dermatology. Available online 13 February 2021. https://doi.org/10.1016/j.clindermatol.2021.02.001

    The Covid-19 era added stress to the lives of already stressed health professionals including resident physicians. This article describes approaches to maintain wellness in dermatology residents.

  9. Brodell, R.T., Byrd, A.C., Firkins-Smith, C., and Nahar, V.K., (Eds.). (In Press). Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives. Cham, Switzerland: Springer Nature. (2021)

    This is the only textbook ever written that considers the full range of issues related to the problem of access to care in rural areas of the United States.
  10. Brodell, D.W., Dolohanty, L.B., Brodell, R.T., Grant-Kels, J.M. The Ethics of Mentoring in Dermatology in Bercovitch L, Perlis C, Stoff, B, Grant-Kels JM. Dermatoethics: Contemporary Ethics and Professionalism in Dermatology. 2020  London (Springer).

    This chapter reviews the ethical issues that impact the mentor and the mentee in the medical center.

  11. Brodell, R.T. Book Review: Dermatoethics: Contemporary Ethics and Professionalism in Dermatology. Journal of the American Academy of Dermatology.  Accepted 4/15/21.

    This is a book review about the most important textbook on dermatologic ethics that has been published.  It is the basis for ethics education in many dermatology programs across the country.

  12. Brodell, R.T. and Dolohanty, L.B. Intertrigo. UpToDate. 2020 Revisions.

    This chapter in the most widely accessed digital publication reviews the diagnosis and treatment of intertrigo.

  13. Brodell, R.T., Jackson, J.D., Grant-Kels, J.M. The Ethics of Service as a Department Chairperson &/or residency director. In Bercovitch L, Perlis C, Stoff B, Grant-Kels JM. Dermatoethics: Contemporary Ethics and Professionalism in Dermatology.2020 London (Springer).

    There are many ethical issues that impact the work of department chairs and residency directors that are reviewed in this textbook chapter.

  14. Brumfiel, C.M., Jefferson, I.S., Wu, A.G., Strunck, J.L., Veerabagu, S., Lin, K., Brodell, R.T., Rosman, I.S. Research Letter: A national webinar for dermatology applicants during the COVID-19 pandemic. Journal of the American Academy of Dermatology.

    The national Dermatology Interest Group Association held a webinar attended by over 1000 medical students during the fall of 2020 to alert them to changes in the application process for the dermatology match.  This article describes the approach that was taken and the evaluations of attendees that demonstrated is was a resounding success.

  15. Casteel, M., LaPolla, M., Brodell, R.T. Woringer-Kolopp Disease of the Foot: A Case Report for review by the Journal of the American Podiatric Medical Association. 2020  110 (6):  1-3.

    A patient with Woringer-Kolopp disease (Pagetoid reticulosis) of the foot is presented. This unusual condition demonstrates the histopathology of Cutaneous T-cell lymphoma presenting as a localized well-circumscribed plaque that is commonly treated with surgical excision. 

  16. Crasto, D.C., Cruse, A.R., Byrd, A.C., Brodell, R.T. Chronic, Non-Healing Ulcer of the Left Leg. The Journal of Family Practice. (2020) 69 (8): 417-419.

    Non-healing leg ulcers are often related to venous stasis, arterial insufficiency, pyoderma, pyoderma gangrenosum, or calciphylaxis.  A patient is presented to emphasize the importance of a biopsy in non-healing ulcers.  In this case, a basal cell carcinoma was identified requiring complete excision.

  17. Davis, R.E., Doyle, N.A., and Nahar, V.K. (2020). An Investigation of the Associations Between Drug-Related Self-Stigmatizing Beliefs, Depression, and Suicidal Ideation among Collegiate Drug Users. Journal of Alcohol and Drug Education, 64(1), 52-80.

    Information about associated self-stigmatizing beliefs and depression in collegiate drug users is critical to determine the most effective approaches to prevention and treatment.

  18. Desrosiers, A.S., Huynh, T.N., Braswell, M.A., Jackson, J.D., Shenoy, V., Brodell, R.T. Images in Dermatology: An immunosuppressed man with widely disseminated violaceous papules and nodules. JAAD Case Reports. March 2020;6(3):250.  https://doi.org/10.1016/j.jdcr.2019.09.028.

    Recipient of American Academy of Dermatology’s Case Challenge of the Month – an image-based learning activity offered for CME/MOC credit on the AAD’s website awarded to the best-case report of the month. A patient with disseminated histoplasmosis is presented to highlight the dramatic clinical and histopathologic findings.

  19. Desrosiers, A.S., Petruzzelli, C.J., Bobo, J.F.G., Hodge, B.D., Rodgers, J.L., Hollinger, J.C., Byrd, A.C., Brodell, R.T. Clinical Interventions Aimed at Expanding Access to Dermatologic Care. Dermatol Online J. Accepted January 7, 2021.

    The efforts of the University of Mississippi Medical Center to improve access to ermatologic care in rural areas is reviewed. The relative benefits of monthly volunteer rural clinics, teledermatology to primary care physician offices, Project Echo Distance learning focused on rural primary care physicians, establishing rural acadmic offices and rural dermatology residency slots are reviewed and compared to assess relative impact.

  20. Doyle, N.A., Davis, R.E., Quadri, S.S.A., Mann, J.R., Sharma, M., Wardrop, R.M., and Nahar, V.K. (2021). Associations between Stress, Anxiety, Depression, and Emotional Intelligence among Medical Students. The Journal of the American Osteopathic Association, 121(2), 125-133.

    It is not surprising that stress, anxiety, and depression occur in medical students. The fact that these findings impact emotional intelligence is somewhat surprising.

  21. Duff, D.B., Desrosiers, A.S., Brodell, R.T., Helms, S.E. Chapter 7: Arachnida and Mites. Dermatologic Manual of Outdoor Hazards. eds. J Trevino and A Chen. 2020:  89-99.

    This book chapter reviews skin diseases caused by arachnids and mites.

  22. Elston, D.M., Grant-Kels, J.M., Levin, N., Alam, M., Altman, E.M., Brodell, R.T.,  Fernandez, A.P., Hurley, Y., Ratner, D., Schaffer, J. Letter from the Editors: Fairness and transparency in medical journals. Journal of the American Academy of Dermatology.

    This white paper outlines the efforts made by the Journal of the American Academy of Dermatology to promote fairness and transparency in the article submission process.

  23. Ezekwe, N., King, M. and Hollinger, J.C. The Use of Natural Ingredients in the Treatment of Alopecias with an Emphasis on Central Centrifugal Cicatricial Alopecia: A Systematic Review. Journal of Clinical and Aesthetic Dermatology. 2020;13(8):23–27.

    Central centrifugal cicatricial alopecia (CCCA), a scarring alopecia that commonly affects women of African descent, can be challenging to manage, and there are limited treatment modalities available. The use of natural ingredients for nonscarring hair loss has gained popularity among patients, but has not been previously studied for CCCA. We sought to review clinical studies evaluating the use of natural ingredients in the treatment of CCCA.

  24. Ezekwe, N., Oberoid, J.K., Brodell, R.T. A Classic Case of Gorlin Syndrome. Pediatrics in Review. (2020) 41 (S1):1-4.

    A young child with Gorlin Syndrome (B-K Mole Syndrome) is presented with numerous lesions that have the clinical appearance of small homogenously pigmented nevi, but on pathology represent basal cell carcinomas. Diagnosis and treatment is discussed.

  25. Ferris, T.S., Partridge, L., Haynie, L. (In Press). Chapter 11: Advanced Practice Providers Role in Rural Dermatology in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    Advanced practice providers have played a major role in rural dermatology practice as discussed in this chapter. 

  26. Fischel, A.E., Helms, S.E., Brodell, R.T. Chapter 223: Scleredema.  Treatment of Skin Disease, 5th edition, eds. M.G. Lebwohl , J. Berth-Jones, W.R. Heyman, I Coulson. Elsevier, 2020.

    Scleredema is a rare, but dramatic, skin condition that is difficult to treat. The clinical findings and treatment options are reviewed in this book chapter.

  27. Garaway, C. and Byrd, A. (In Press). Chapter 17: Rural dermatology private practice: a life worth living in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    The joys of a rural dermatology practice are emphasized in this chapter.

  28. Harber, I., Shenoy, T., Cruse, A., and Brodell, R.T. Adult Colloid Milium is Clinically Distinguishable from its Histopathologic Mimic Cutaneous Amyloidosis.  Dermatology Online Journal. Accepted April 30,

    Adult colloid Milium is a rare finding that occurs in severely sun-damaged skin.`Histopathologically it resembles cutaneous amyloidosis, but the clinical presentations are quite different.

  1. Kala, M. and Sisson, W.T. (In Press). Chapter 3: Economics of rural dermatology practice in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    The economics of rural dermatology practices are presented in this chapter.
  1. Lewis, K. and Harber, I.D. (In Press). Chapter 10: Private practice rural dermatology offices in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    A successful private dermatology practice is possible in rural America as discussed in this chapter. 
  1. Matzek, C.N., Brodell, R.T., and Nahar, V.K. (2020). Asymptomatic Papulovesicles Arising in 48 Hours [Teledermatology Viewpoint]. Journal of the Dermatology Nurses' Association, 12(6), 304-305.

    Images of a patient with polymorphous light eruption were submitted for teledermatology interpretation. The history and clinical findings of “sun poisoning” are reviewed.
  1. McCowan, H., Hoang, H., Pfleger, M., McCowan, N. (In Press). Chapter 19: Free rural clinics: city folk making a difference in rural America in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    This chapter reviews the approach to setting up successful free clinics to help with access to care problems in rural America. 
  1. McTighe, R., Mosby, A., Harber, I.D., Mockbee, C.S. (In Press). Chapter 14: Delivering “store and forward” teledermatology to rural primary care practices: an efficient approach to provision of rural skin care in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    This chapter reviews the approach to a successful teledermatology practice that reached into rural America. 
  1. Morrissette, S., Pearlman, R.L., Kovar, M., Sisson, W.T., Brodell, R.T., Nahar, V.K. Attitudes and perceived barriers toward store-and-forward teledermatology among primary care providers of the rural Mississippi. Archives of Dermatological Research (2021). https://doi.org/10.1007/s00403-021-02208-z

    Mississippi has many advantages that support the use of teledermatology including laws that mandate that all insurance companies offer teledermatology services from approved providers and reimburse at the same rate as an in person visit. However, barriers persist that limit the number of teledermatology consultations coming from primary care physician’s offices.  Primary among these barriers is the lack of time to submit the consultation in a busy office that requires the submission process be simplified.
  1. Nahar, L. and Brodell, R.T. Sudden Onset of a Worrisome Black Lesion [Teledermatology Viewpoint]. Journal of the Dermatology Nurses' Association, 2020: 12(6), 302-303.

    Talon noir appears acutely as a jet-black lesion most commonly on the heel. In this case a lesion occurred on the thumb after the skin was pinched. Health care providers unaware of this condition could mistake this lesion for malignant melanoma. 
  1. Nahar, L., and Brodell, R.T. Transient, Pruritic Linear Eruption on the Arms. The Journal of the Dermatology Nurses' Association, 2020.:12(3), 133-134.

    The classic findings of poison ivy are discussed in this brief case report. 
  1. Noble, C.A., Bhate, C., Buong, B., Cruse, A.R. Clinical-pathologic Correlation: The Impact of Grossing at the Bedside. Seminars in Diagnostic Pathology, Accepted March 1, 2021.

    Dermatologists routinely accept the importance of clinical-pathologic correlation once they have a pathology report in hand. This article stresses the importance of clinical-pathologic correlation before a blade touches the patient’s skin.
  1. Ortego, J. and Burrow, H. (In Press). Chapter 4: Government and private efforts to incentivize rural practice (low interest loans, grants, etc.). Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    This book chapter reviews governmental efforts to incentivize the practice of dermatology in rural areas. 
  1. Patel, F.C., Raines, J.A., Kim, R.W., Gruszynski, K., Davis, R.E., Sharma, M., Patterson, G., Johnson, J.W. and Nahar, V.K. (2020). Veterinarians’ Attitudes and Practices regarding Opioid-related Vet Shopping in Tri-State Appalachian Counties: An Exploratory Study. BMC Veterinary Research, 16, 210.

    This article reviews attitudes and practices of veterinarians who can become victims of drug-seeking individuals. 
  1. Pearlman, R., Harrington, H., Flischel, A. (In Press). Chapter 7: Training medical students in a rural dermatology clinic in  Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    The organizational requirements and benefits of training medical students in rural dermatology clinics is reviewed in this chapter. 
  1. Pearlman, R.L., Le, P.B., Brodell, R.T., Nahar, V.K. Evaluation of patient attitudes towards the technical experience of synchronous teledermatology in the era of COVID-19. Archives of Dermatological Research (2021). https://doi.org/10.1007/s00403-020-02170-2

    The COVID-19 pandemic taught all physicians that there are technical glitches than can impact the effectiveness of this approach. This study focused on the patients attitudes toward the technology that underpins teledermatology. 
  1. Pearlman, R., McCandless, M., Flischel, A., Kovarik, C. (In Press). Chapter 5: The Practice of Austere (resource-limited) Dermatology in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    The challenges of practicing dermatology in austere rural settings are covered in this chapter. 
  1. Pearlman, R.L., Patel, V., Davis, R.E. Ferris, T.S., Gruszynski, K., Elledge, T., Bhattacharya, K., Nahar, V.K. Effects of health beliefs, social support, and self-efficacy on sun protection behaviors among medical students: testing of an extended health belief model. Archives of Dermatological Research (2020). https://doi.org/10.1007/s00403-020-02123-9

    Little is known about the factors that cause individuals to use sunscreen in an effort to avoid the hazards of tanning. This article assesses factors related to self-efficacy that impact sun-screen use among medical students. 
  1. Petruzzelli, C., Brown, A.S., Dowling, K., Doo, C., Brodell, R.T. (In Press). Chapter 15: Overcoming barriers to implementation of teledermatology in Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    This chapter discusses approaches to overlying barriers to telehealth practice in rural America. 
  1. Roberts, J.E., Sharma, M., Thomley, M.E., Nahar, V.K. (In Press). Chapter 16: Health services research in rural dermatology in  Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives.

    Rural clinics are the setting for important health services research as reviewed in this chapter. 
  1. Roberts, J.E., Thomley, M.E., Sharma, M., and Nahar, V.K. (2021). Chapter 18: Worldwide Rural Dermatology Health Services Research. In R.T. Brodell, A. C. Byrd, C. Firkins-Smith, & V. K. Nahar (Eds.), Dermatology in Rural Settings: Organizational, Clinical, and Socioeconomic Perspectives. Cham, Switzerland: Springer Nature.

    The focus of this research should be in several areas that promise the potential for improving rural healthcare.   
  1. Roland, D., Wile, A.A., Brodell, R.T., Mostow, E.N., Jackson, J.D. Medical Student Dermatology Research Initiative- A Step-By-Step Process to Successful Writing of Scientific Articles. American Medical Student Research Journal, Accepted February 28, 2021.

    Medical students applying to highly competitive residencies are expected to involve themselves in clinical research and this is most commonly measured by numbers of accepted publications. An effective approach to teaching medical students a method to successfully write articles with a high likelihood of publication is presented. 
  1. Shaloam, D, Yedjou, C.G., Brodell, R.T., Cruse, A., Tchounwou, P.B. Therapeutic strategies and potential implications of silver nanoparticles in the management of skin cancer. Nanotechnology Reviews. (2020) 9: 1500–1521.   https://doi.org/10.1515/ntrev-2020-0117.

    The basic science behind the use of silver nanoparticles in the management of skin cancer is reviewed to stimulate interest in developing this novel treatment approach. 
  1. Sharma, M., Batra, K., and Nahar, V.K. Alcohol consumption in COVID-19 pandemic: Implications for alcohol education. Journal of Alcohol and Drug Education, 2020: 64(2), 8-19.

    It is not surprising that the consumption of alcohol increased during the COVID-19 pandemic. This article reviews the implications of this finding as the pandemic wanes. 
  1. Sharma, M., Batra, K., Singh, T. P., Dua, R., Ickes, M., Batra, R., and Nahar, V.K. (in press). Explaining screen-time (ST) behavior among preschoolers in Northern India using multi theory model (MTM): A parental cross-sectional survey. International Quarterly of Community Health Education. Accepted March 5, 2021.

    A multi-theory model is used to explain screen-time among preschoolers in northern India. 
  1. Sharma, M., Chandra, A., Toth, R., and Nahar, V.K. Utility of Multi-Theory Model (MTM) to Explain the Intention for PAP Adherence in Newly Diagnosed Sleep Apnea. Nature and Science of Sleep. 2021: 13: 263-271.

    Efforts to impact adherence to treatment of sleep apnea require a multi-modal approach that was assessed in this preliminary study. 
  1. Spell, C., Badon, H.R., Flischel, A., Brodell, R.T. Chapter 6: Acne and Rosacea in Pregnancy. In Cutaneous Disorders of Pregnancy. Kelly Tyler, ed.

    Acne and rosacea are common in pregnant women. This book chapter reviews the diagnosis and treatment of these conditions. 
  1. Spell, C.A., Pearlman, R.L., Brodell, R.T., Nahar, V.K. Teledermatology Before and After COVID-19: The Impact of Regulation.  The Journal of the Mississippi State Medical Association (Special Edition: COVID-19 in Mississippi: Lessons Learned at UMMC) (2020) 61 (11): 418-421.

    This article described the dramatic increase in teledermatology that occurred during the spring of 2020 at the height of the COVID-19 pandemic that was the result of deregulation by the federal government. 
  1. Stashower, J., Bruch, K., Mosby, A., Boddie, P.P., Varghese, J.A., Rangel, S.M., Brodell, R.T., Zheng, L., Flowers, R.H. Pregnancy complications associated with pityriasis rosea: A multicenter retrospective study. Journal of the American Academy of Dermatology. 2021 Jan 8:S0190-9622(21)00080-3. doi: 10.1016/j.jaad.2020.12.063. Epub ahead of print. PMID: 33422632.

    This retrospective multicenter study assessed the complications that occur following the diagnosis of pityriasis rosea in pregnancy. The findings found no significant complications, but the need for a larger study was noted. 
  1. Streifel, A., Wessman, L.L., Farah, R.S., Gaddis, K.J., Byrd, A., Brodell, R.T., Firkins Smith, C.  Rural Residency Curricula: Potential Target for Improved Access to Care? Cutis (2021) 107 (1): 54-55.

    This article reviews the websites of all dermatology residency programs as a window to their curricula. There is surprisingly little emphasis on rural dermatology on display. 
  1. Thomley, M.E., Roland, D.L., Noble, C.A., Sharma, M., Shipley, S.R., and Nahar, V.K. (2021). Skin Cancer in Skin of Color: The Importance of Expanding Education and Prevention Efforts to Include this Community. Journal of the Dermatology Nurses' Association, 13(2), 106-109.

    It is critical to educate all segments of society including those with skin of color about the risks of skin cancer and the benefits of early detection and treatment. 
  2. Wells, J., Watson, K., Davis, R.E., Quadri, S.S.A., Mann, J.R., Verma, A., Sharma, M., and Nahar, V.K. (2021). Associations among Stress, Anxiety, Depression, and Emotional Intelligence among Veterinary Medicine Students. International Journal of Environmental Research and Public Health, 18(8), 1-8.

    The association between stress, anxiety, depression, and emotional intelligence among veterinary medicine students must be understood before appropriate efforts can be made to prevent and treat these conditions.

April 2021

  1. Chappell, B.T., Mena, L.A., Maximos, B., Mollan, S., Culwell, K., Howard, B. EVO100 prevents chlamydia and gonorrhea in women at high risk of infection. American Journal of Obstetrics and Gynecology. 2021 Mar 8:S0002-9378(21)00156-3. doi: 10.1016/j.ajog.2021.03.005. Epub ahead of print. PMID: 3370574

    According to the Centers for Disease Control and Prevention, rates of infection for Chlamydia trachomatis and Neisseria gonorrhoeae are increasing in the United States. EVO100 is an investigational antimicrobial, pH-modulating, vaginal gel with active ingredients L-lactic acid, citric acid, and potassium bitartrate that is being evaluated for the prevention of sexually transmitted infections. The objective of this phase 2B/3 study was to assess the efficacy and safety of EVO100 for the prevention of chlamydia and gonorrhea. AMPREVENCE was a double-blinded, placebo-controlled, multicenter study based in the United States conducted over approximately 16 weeks in women at the age of 18 to 45 years who were at risk of urogenital chlamydia and gonorrhea infection. Enrolled women had been diagnosed as having and treated for chlamydia or gonorrhea ≤16 weeks before enrollment. Women received either EVO100 or placebo vaginal gel and were instructed to apply the study drug immediately before or up to 1 hour before each act of vaginal sexual intercourse. The primary and secondary endpoints were the prevention of urogenital chlamydia and gonorrhea, respectively. Exploratory outcomes include women's overall satisfaction with EVO100. EVO100 significantly reduced the risk of chlamydia and gonorrhea infections in women at high risk of Chlamydia trachomatis and Neisseria gonorrhoeae infection and was well tolerated, with observed adverse events consistent with its known safety profile.

  2. Cowles, C., Lake, C., Ehrenwerth, J. Surgical Fire Prevention: A Review. APSF Newsletter. 2020 Oct, 82-83.

    The thought of a fire in the operating room sends chills down the spines of the health professionals that are trusted to ensure our patient's safety." The dreaded complication which often results in severe and disfiguring injuries can be eradicated at a minimal cost and should be a continued focus for the Anesthesia Patient Safety Foundation (APSF)." The paper, recently published in the 35th Anniversary of the APSF Newsletter is a continual review of operating room fires, the issues that follow such events, the elements that are present in such a complication, and recommendations for dealing with the event as well as a review of preventive measures.

  3. Gardner, S.K., Walker, C.S., Love, T., Singel, S. & Buttross, S. (2021). Top 10 Facts You Need to Know about ECH-ECHO. Journal of the Mississippi State Medical Association  X(X), X-X. https://doi.org/

    Many Mississippi communities lack access to specialists who are trained in the identification and treatment of young children with developmental and behavioral disorders. Primary care pediatricians are often tasked with identifying and managing children in need of developmental and behavioral services; however, the majority of primary care pediatricians report that they do not have the training or confidence to correctly identify and treat the children in need of such services. In recent years, telementoring has become an increasingly common way to educate and empower primary care pediatricians to confidently manage the developmental and behavioral health of their patients. The University of Mississippi Medical Center (UMMC) established the Early Childhood (ECH) ECHO program to help enhance primary care providers’ capacity to manage their patients’ care within the medical home and to support the delivery of evidence-based developmental and behavioral health care.

  4. Garg, P. M., Bernieh, A., Hitt, M. M., Kurundkar, A., Adams, K.V., Blackshear, C., Maheshwari, A., Saad, A.G. (2021). Incomplete resection of necrotic bowel may increase mortality in infants with necrotizing enterocolitis. Pediatric Research, 89(1), 163–170. https://doi.org/10.1038/s41390-020-0975-6

    Infants with advanced necrotizing enterocolitis (NEC) often need surgical resection of necrotic bowel. We hypothesized that incomplete resection of NEC lesions, signified by the detection of necrotic patches in margins of resected bowel loops, results in inferior clinical outcomes. We reviewed the medical records of infants with surgical NEC in the past 15 years for demographic, clinical, and histopathological data. We also developed statistical models to predict mortality and hospital stay. Ninety infants with surgical NEC had a mean (±standard error) gestational age of 27.3 ± 0.4 weeks, birth weight 1008 ± 48 g, NEC onset at 25.2 ± 2.4 days, and resected bowel length of 29.2 ± 3.2 cm. Seventeen (18.9%) infants who had complete resection of the necrosed bowel had fewer (4; 23.5%) deaths and shorter lengths of hospital stay. In contrast, a group of 73 infants with some necrosis within the margins of resected bowel had significantly more (34; 46.6%) deaths and longer hospital stay. The combination of clinical and histopathological data gave better regression models for mortality and hospital stay. In surgical NEC, incomplete resection of necrotic bowel increased mortality and the duration of hospitalization. Regression models combining clinical and histopathological data were more accurate for mortality and the length of hospital stay.

  5. Garg, P. M., Britt, A. B., Ansari, M.A.Y., Sobisek, S., Block, D.K., Paschal, J.L. Ojeda, N.B., Askenazi, D., Sanderson, K. R. (2021). Severe acute kidney injury in neonates with necrotizing enterocolitis: risk factors and outcomes. Pediatric Research, 2021 Jan 14. https://doi.org/10.1038/s41390-020-01320-6

    The aim of this work is to study the risk factors and outcomes of severe acute kidney injury (AKI) in neonates with necrotizing enterocolitis. Retrospective chart review of 202 neonates with necrotizing enterocolitis (NEC) (Bell stage >IIa) from 2013 to 2018. AKI was defined as per-modified neonatal Kidney Disease: Improving Global Outcomes criteria. Demographic, clinical, and outcome data were compared between neonates without severe AKI (stage 0 and 1 AKI) and those with severe AKI (stage 2 and 3 AKI). Severe AKI occurred in 66/202 (32.6%) of neonates after NEC diagnosis and after 61/104 (58.7%) of surgical NEC diagnoses. On adjusted model, surgical NEC [adjusted odds ratio (aOR) = 30.6; 95% confidence interval (CI) = 8.9, 130.6], outborn [aOR = 3.9; 95% CI = 1.54, 11.0], exposure to antenatal steroids [aOR = 3.0; 95% CI = 1.1, 8.9], and positive blood culture sepsis [aOR = 3.5; 95% CI = 1.3, 10.0] had increased odds for severe AKI. Those with severe AKI required longer hospitalization [124 days (interquartile range (IQR) 88–187) vs. 82 days (IQR 42–126), p < 0.001]. Severe AKI is common in neonates with NEC who require surgical intervention, are outborn, have positive blood culture sepsis, and receive antenatal steroids. Severe AKI is associated with a significantly longer length of hospitalization.

  6. Garg, P. M., Hitt, M. M., Blackshear, C., & Maheshwari, A. (2020). Clinical determinants of postoperative outcomes in surgical necrotizing enterocolitis. Journal of Perinatology, 40(11), 1671–1678. https://doi.org/10.1038/s41372-020-0728-8

    The aim is to investigate predictors of postoperative morbidity and mortality in surgical NEC. We analyzed the clinical outcomes of infants with surgical NEC from the years 2000–2015. Ninety infants born at gestation (mean ± standard deviation, SD; standard error of mean, SEM) 27.3 ± 6.6 weeks (SEM ± 0.07 weeks) and weighing 1008 ± 456 g (SEM ± 48 g) developed NEC on 25.2 ± 22.4 days (SEM± 2.4 days). Average bowel resection was 29.2 ± 30.5 cm (SEM ± 3.2 cm). Postoperative Ileus lasted 16.5 ± 12.2 days (SEM± 1.3 days), and was significantly longer in infants with higher gestation and birth weight, age at onset of NEC, length of intestinal resection, maternal chorioamnionitis, and need for pressors. Thirty-eight (42.2%) infants died. Mortality was higher at gestation <31 weeks. Gestational age, birth weight, age at NEC onset, and length of resected bowel determined postoperative morbidity and mortality in NEC. Length of hospital stay was affected by above factors, and also the duration of postoperative ileus and parenteral nutrition.

  7. Garg, P. M., O'Connor, A., Ansari, M.A.Y., Vu, B., Hobart, H., Paschal, J. L., Multani, H., Josephson, C.D., Okhomina, V. (2021). Hematological predictors of mortality in neonates with fulminant necrotizing enterocolitis. Journal of Perinatology: Official Journal of the California Perinatal Association, 2021 Mar 26. https://doi.org/10.1038/s41372-021-01044-3

    The objective is to determine whether hematological and transfusion patterns following, the onset of NEC can identify infants likely to develop fulminant, fatal necrotizing enterocolitis (NEC). The design was to determine hematological predictors of fulminant NEC. Of 336 neonates with NEC, 35 (10%) who developed fulminant NEC were born with higher birth weights and more frequently developed radiologically evident pneumoperitoneumand/or portal venous gas. Following the diagnosis of NEC, these infants were more likely to rapidly develop thrombocytopenia, lymphopenia, neutropenia, and lower total white blood cell counts compared to medical/surgical non-fulminant type. They were also more likely to have received a red blood cell (RBC) transfusion (76.7% vs. 53.1%, p = 0.001) within 48 h after disease onset and platelet transfusion (24.2% vs. 11.7%; p = 0.03) before the onset of NEC. Neonates with fulminant NEC frequently developed thrombocytopenia, lymphopenia, neutropenia, and leukopenia, received RBC transfusions after or platelet transfusions before the onset of NEC developed the fulminant disease.

  8. Ghaleb, S., Wittekind, S. G., Martinez, H., Kasten, J., Gao, Z., Hengehold, T., & Chin, C. (2021). Antithymocyte globulin induction therapy and myocardial complement deposition in pediatric heart transplantation. Pediatric Transplantation, E13998, 13998. https://doi.org/10.1111/petr.13998

    Antithymocyte globulin (ATG) consists of polyclonal antibodies directed primarily against human T lymphocytes but may contain antibodies with affinity for other tissues in the transplanted organ, resulting in complement (C4d) deposition. This phenomenon has been demonstrated in endomyocardial biopsies (EMBs) of adult cardiac transplants. We examined the relationship of induction immunosuppression with ATG and C4d deposition in EMB of pediatric cardiac transplants. Results of C4d immunohistochemistry were available from all EMB of patients transplanted at our center between June 2012 and April 2018 (n = 48) who received induction immunosuppression with either ATG (n = 20) or basiliximab (n = 28) as the standard of care. C4d deposition in the first year post-heart transplant was more commonly seen among patients who received ATG induction (20% of EMBs in ATG group vs 1% of EMBs in basiliximab group; p < .0001). C4d deposition related to ATG was observed early post-transplant (50% ATG vs 0% basiliximab on first EMB; p < .0001 and 35% ATG vs 0% basiliximab on the second EMB; p = .0012). While this difference waned by the third EMB (5% ATG vs 0% basiliximab; p = .41), positive C4d staining persisted to the sixth EMB in the ATG group only (6%). C4d deposition is common on EMB up to 1 year post-pediatric cardiac transplant following ATG induction. This high rate of positive C4d staining in the absence of histologic AMR after ATG induction therapy must be accounted for in making clinical decisions regarding cardiac allograft rejection diagnosis and treatment.

  9. Gomez-Sanchez, E.P., Gomez-Sanchez, C.E. 11β-hydroxysteroid dehydrogenases: A growing multi-tasking family. Molecular and Cellular Endocrinology, Volume 526, 2021, 111210, ISSN 0303-7207, https://doi.org/10.1016/j.mce.2021.111210.

    This review briefly addresses the history of the discovery and elucidation of the three cloned 11β-hydroxysteroid dehydrogenase (11βHSD) enzymes in the human, 11βHSD1, 11βHSD2 and 11βHSD3, an NADP+-dependent dehydrogenase also called the 11βHSD1-like dehydrogenase (11βHSD1L), as well as evidence for yet identified 11βHSDs. Attention is devoted to more recently described aspects of this multi-functional family. The importance of 11βHSD substrates other than glucocorticoids including bile acids, 7-keto sterols, neurosteroids, and xenobiotics is discussed, along with examples of pathology when functions of these multi-tasking enzymes are disrupted. 11βHSDs modulate the intracellular concentration of glucocorticoids, thereby regulating the activation of the glucocorticoid and mineralocorticoid receptors, and 7β-27-hydroxycholesterol, an agonist of the retinoid-related orphan receptor gamma (RORγ). Key functions of this nuclear transcription factor include regulation of immune cell differentiation, cytokine production and inflammation at the cell level. 11βHSD1 expression and/or glucocorticoid reductase activity are inappropriately increased with age and in obesity and metabolic syndrome (MetS). Potential causes for disappointing results of the clinical trials of selective inhibitors of 11βHSD1 in the treatment of these disorders are discussed, as well as the potential for more targeted use of inhibitors of 11βHSD1 and 11βHSD2.

  10. Hyacinth, H. I., Franceschini, N., Seals, S.R., Irvin, M.R., Chaudhary, N., Naik, R.P., …Correa, A., … Safford, M.M. (2021). Association of sickle cell trait with incidence of coronary heart disease among african american individuals. JAMA Network Open, 4(1), 2030435. https://doi.org/10.1001/jamanetworkopen.2020.30435

    The incidence of and mortality from coronary heart disease (CHD) are substantially higher among African American individuals compared with non-Hispanic White individuals, even after adjusting for traditional factors associated with CHD. The unexplained excess risk might be due to genetic factors related to this cohort study included 5 large, prospective, population-based cohorts of African American individuals in the Women’s Health Initiative (WHI) study, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, the Multi-Ethnic Study of Atherosclerosis (MESA), the Jackson Heart Study (JHS), and the Atherosclerosis Risk in Communities (ARIC) study. The follow-up periods included in this study were 1993 and 1998 to 2014 for the WHI study, 2003 to 2014 for the REGARDS study, 2002 to 2016 for the MESA, 2002 to 2015 for the JHS, and 1987 to 2016 for the ARIC study. Data analysis began in October 2013 and was completed in October 2020. Sickle cell trait status was evaluated by either direct genotyping or high-quality imputation of rs334 (the sickle cell variant). Participants with sickle cell disease and those with a history of CHD were excluded from the analyses. Incident MI, defined as adjudicated nonfatal or fatal MI, and incident CHD, defined as adjudicated nonfatal MI, fatal MI, coronary revascularization procedures, or death due to CHD. Cox proportional hazards regression models were used to estimate the hazard ratio for incident MI or CHD comparing SCT carriers with noncarriers. Models were adjusted for age, sex (except for the WHI study), study site or region of residence, hypertension status or systolic blood pressure, type 1 or 2 diabetes, serum high-density lipoprotein level, total cholesterol level, and global ancestry (estimated from principal components analysis). In this cohort study, there was not an association between SCT and increased risk of MI or CHD in African American individuals. These disorders may not be associated with sickle cell trait–related sudden death in this population.

  11. Kassahun-Yimer, W., Valle, K.A., Oshunbade, A.A., Hall, M. E., Min, Y.I., Cain-Shields, L., Anugu, P., Correa, A. (2020). Joint modelling of longitudinal lipids and time to coronary heart disease in the jackson heart study. BMC Medical Research Methodology, 20(1). https://doi.org/10.1186/s12874-020-01177-7

    Multiple longitudinal responses together with time-to-event outcome are common in biomedical studies. There are several instances where the longitudinal responses are correlated with each other and at the same time each longitudinal response is associated with the survival outcome. The main purpose of this study is to present and explore a joint modeling approach for multiple correlated longitudinal responses and a survival outcome. The method will be illustrated using the Jackson Heart Study (JHS), which is one of the largest cardiovascular studies among African Americans. Four longitudinal responses, i.e., total cholesterol (TC), high density lipoprotein (HDL) cholesterol, triglyceride (TG) and inflammation measured by high-sensitivity C-reactive protein (hsCRP); and time-to-coronary heart disease (CHD) were considered from the JHS. The repeated lipid and hsCRP measurements from a given subject overtime are likely correlated with each other and could influence the subject’s risk for CHD. A joint modeling framework is considered. To deal with the high dimensionality due to the multiple longitudinal profiles, we use a pairwise bivariate model fitting approach that was developed in the context of multivariate Gaussian random effects models. The method is further explored through simulations. The proposed model performed well in terms of bias and relative efficiency. The JHS data analysis showed that lipid and hsCRP trajectories could exhibit interdependence in their joint evolution and have impact on CHD risk. We applied a unified and flexible joint modeling approach to analyze multiple correlated longitudinal responses and survival outcome. The method accounts for the correlation among the longitudinal responses as well as the association between each longitudinal response and the survival outcome at once. This helps to explore how the combination of multiple longitudinal trajectories could be related to the survival process.

  12. Lin, B.M., Grinde, K.E., Brody, J.A., Breeze, C.E., Raffield, L.M., Mychaleckyj, J.C., Correa, A., … Franceschini, N. (2021). Whole genome sequence analyses of egfr in 23,732 people representing multiple ancestries in the nhlbi trans-omics for precision medicine (topmed) consortium. Ebiomedicine, 63, 103157–103157. https://doi.org/10.1016/j.ebiom.2020.103157

    Genetic factors that influence kidney traits have been understudied for low frequency and ancestry-specific variants. We combined whole genome sequencing (WGS) data from 23,732 participants from 10 NHLBI Trans-Omics for Precision Medicine (TOPMed) Program multi-ethnic studies to identify novel loci for estimated glomerular filtration rate (eGFR). Participants included European, African, East Asian, and Hispanic ancestries. We applied linear mixed models using a genetic relationship matrix estimated from the WGS data and adjusted for age, sex, study, and ethnicity. When testing single variants, we identified three novel loci driven by low frequency variants more commonly observed in non-European ancestry (PRKAA2, rs180996919, minor allele frequency [MAF] 0.04%, P = 6.1 × 10−11; METTL8, rs116951054, MAF 0.09%, P = 4.5 × 10−9; and MATK, rs539182790, MAF 0.05%, P = 3.4 × 10−9). We also replicated two known loci for common variants (rs2461702, MAF=0.49, P = 1.2 × 10−9, nearest gene GATM, and rs71147340, MAF=0.34, P = 3.3 × 10−9, CDK12). Testing aggregated variants within a gene identified the MAF gene. A statistical approach based on local ancestry helped to identify replication samples for ancestry-specific variants. This study highlights challenges in studying variants influencing kidney traits that are low frequency in populations and more common in non-European ancestry.

  13. Medina, A., Songcharoen, S., Velasco Martinez, I. (2021). Management of posterior maxillary ameloblastoma with scapular tip free flap. Ann Case Reports 6(1):1-5.

    Publication date: 01/25/2021. DOI: 10.29011/2574-7754.100574

    Maxillary ameloblastomas are rare odontogenic epithelial tumors predominantly located in the posterior segment of the maxilla. Due to their anatomical confinement and difficulties for successful resection, these tumors show high risk of postoperative complications and recurrence. The reconstruction with vascularized bone grafts appears to be a reasonable option for optimal cosmetic and functional results. We present a case of maxillary ameloblastoma located at molar region treated with extensive resection and scapular tip free flap.

  14. Medina, A., Velasco Martinez, I., McIntyre, B., Chandran, R. (2021). Ameloblastoma: Clinical presentation, management and outcome. Case Reports in Plastic Surgery and Hand Surgery, 8(1): 27-36. Publication date: 2/22/2021. DOI: 10.1080/23320885.2021.1886854

    Ameloblastoma is a benign but locally destructive lesion of the jaws that represent 10% of the odontogenic tumors. This retrospective study reports on 21 patients who underwent radical tumor excision followed by different options of immediate defect reconstruction between 2015 and 2020. We analyzed clinical presentation, preoperative assessment, options of surgical reconstruction and their indications, postoperative complications and their contributing factors and long-term outcomes. Interestingly, patients’ comorbidities, chronic use of medications, chronic consumption of alcohol and/or tobacco and BMI status did not contribute to the development of postoperative complications or increase hospital stay. By contrast, the presence of giant ameloblastoma (≥5cm) and/or tumor involving bony curvatures not only increased the complexity of the procedure for contour reconstruction, but they also presented a statistically significant higher incidence of postoperative complications (P-value of 0.04). Furthermore, the presence of giant tumors and use of fibula free flap significantly prolonged the length of stay (P-values of 0.02 and 0.001, respectively). All patients recovered without major limitations. The incorporation of dental implants and inferior alveolar nerve restoration have increased our functional outcomes and patients’ satisfaction. The management of ameloblastomas requires a multidisciplinary team with experience in ablative and reconstructive surgeries, oral rehabilitation (i.e., dental implants, speech, etc.) as well as managing the social and emotional aspects of this disease. A long-term commitment and collaborative effort from the team as well as patients and their families are crucial to optimize results.

  15. Medina, A., Velasco Martinez, I., Nguyen, Q.C. (2021). Immediate allograft reconstruction of the infraorbital nerve following resection of polyostotic fibrous dysplasia lesion. Case Reports in Plastic Surgery and Hand Surgery, 8(1): 12-17. Publication date: 2/5/2021. DOI: 10.1080/23320885.2021.1883435

    Processed nerve allografts (PNA) have increasingly been used as alternative to autogenous nerve grafts to repair nerve injuries in oral-maxillofacial surgeries. This case report describes an immediate PNA reconstruction of infraorbital nerve injury sustained during the ablation of a large expansile polyostotic fibrous dysplasia centered in the left maxilla.

  16. Min, Y.I., Gao, Y., Anugu, P., Anugu, A., & Correa, A. (2021). Obesity and overall mortality: findings from the Jackson Heart Study. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-020-10040-9

    Overall mortality has been reported to be lower among individuals classified as overweight/obese when compared with their normal weight counterparts (“obesity paradox”) when obesity classification is based on the body mass index (BMI). One possible reason for this apparent paradox is that BMI is not a reliable measure of obesity-related risk as it does not differentiate fat mass from lean muscle mass or fat mass phenotypes. Waist circumference (WC), as a measure of central adiposity, may be a better indicator of obesity-related risk. We examined the association of overall mortality with BMI and with WC measures, including WC, waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR). Data from 3976 African American participants (551 deaths) in the Jackson Heart Study (JHS) were analyzed. Cox regression models were used to perform survival analysis. Obesity measures were analyzed as dichotomous (obese/non-obese) and continuous variables. Baseline covariates included age, sex and smoking status. Comparing obese to non-obese participants, adjusted hazard ratios (95% CI) for overall mortality were 1.14 (0.96, 1.35), 1.30 (1.07, 1.59), 1.02 (0.73, 1.41) and 1.45 (1.18, 1.79) when using BMI, WC, WHtR and WHR, respectively. For BMI, WC and WHtR, a J-shaped relationship was observed with overall mortality. For WHR, a monotonic increasing relationship was observed with overall mortality. In the JHS, we found that obesity as defined by WC and WHR was associated with an increased risk of overall and CVD mortality, while obesity defined by BMI was associated only with an increased risk of CVD mortality. WHR was the only obesity measure that showed a monotonic increasing relationship with overall and CVD mortality.

  17. Muzny, C.A., Schwebke, J.R., Nyirjesy, P., Kaufman, G., Mena, L.A., Lazenby, G.B., Van Gerwen, O.T., Graves, K.J., Arbuckle, J., Carter, B.A., McMahon, C.P., Eder, S., Shaw, J., Pandey, B., Chavoustie, S.E. Efficacy and Safety of Single Oral Dosing of Secnidazole for Trichomoniasis in Women: Results of a Phase 3, Randomized, Double-Blind, Placebo-Controlled, Delayed-Treatment Study. Clinical Infectious Diseases. 2021 Mar 26:ciab242. doi: 10.1093/cid/ciab242. Epub ahead of print. PMID: 33768237.

    Trichomonas vaginalis is the most prevalent non-viral sexually transmitted infection. We evaluated the efficacy and safety of secnidazole vs. placebo in women with trichomoniasis. Women with trichomoniasis, confirmed by a positive T. vaginalis culture, were randomized to single-dose oral secnidazole 2g or placebo. The primary endpoint was microbiological test of cure (TOC) by culture 6-12 days after dosing. At the TOC visit, participants were given the opposite treatment. They were followed for resolution of infection afterward and offered treatment at subsequent visits, if needed. Fifty patients per group (N=100) provided ~95% power to detect a statistically significant difference between treatment groups. Between April 2019 and March 2020, 147 women enrolled at 10 US sites. The modified intent-to-treat (mITT) population included 131 randomized patients (64/67, in secnidazole/placebo). Cure rates were significantly higher in the secnidazole vs. placebo group (92.2% [95% CI: 82.7-97.4] vs. 1.5% [95% CI: 0.0-8.0]) for the mITT population and for the per-protocol population (94.9% [95% CI: 85.9-98.9]) vs. 1.7% [95% CI: 0.0-8.9]). Cure rates were 100% (4/4) in women with HIV and 95.2% (20/21) in women with bacterial vaginosis (BV). Secnidazole was generally well tolerated. The most frequently reported treatment-emergent adverse events (TEAEs) were vulvovaginal candidiasis and nausea (each 2.7%). No serious TEAEs were observed. A single oral 2g dose of secnidazole was associated with significantly higher microbiological cure rates vs. placebo, supporting a role for secnidazole in treating women with trichomoniasis, including those with HIV and/or BV.

  18. Nielsen, J. B., Rom, O., Surakka, I., Graham, S.E., Zhou, W., Roychowdhury, T., …, Correa, A., …, Hveem, K. (2020). Loss-of-function genomic variants highlight potential therapeutic targets for cardiovascular disease. Nature Communications, 11(1), 6417–6417. https://doi.org/10.1038/s41467-020-20086-3

    Pharmaceutical drugs targeting dyslipidemia and cardiovascular disease (CVD) may increase the risk of fatty liver disease and other metabolic disorders. To identify potential novel CVD drug targets without these adverse effects, we perform genome-wide analyses of participants in the HUNT Study in Norway (n = 69,479) to search for protein-altering variants with beneficial impact on quantitative blood traits related to cardiovascular disease, but without detrimental impact on liver function. We identify 76 (11 previously unreported) presumed causal protein-altering variants associated with one or more CVD- or liver-related blood traits. Nine of the variants are predicted to result in loss-of-function of the protein. This includes ZNF529:p.K405X, which is associated with decreased low-density-lipoprotein (LDL) cholesterol (P = 1.3 × 10−8) without being associated with liver enzymes or non-fasting blood glucose. Silencing of ZNF529 in human hepatoma cells results in upregulation of LDL receptor and increased LDL uptake in the cells. This suggests that inhibition of ZNF529 or its gene product should be prioritized as a novel candidate drug target for treating dyslipidemia and associated CVD.

  19. Surendran, P., Feofanova, E.V., Lahrouchi, N., Ntalla, I., Karthikeyan, S., Cook, J., …, Correa, A., …, Rosendaal, F. R. (2020). Discovery of rare variants associated with blood pressure regulation through meta-analysis of 1.3 million individuals. Nature Genetics, 52(12), 1314–1332.

    Genetic studies of blood pressure (BP) to date have mainly analyzed common variants (minor allele frequency, MAF > 0.05). In a meta-analysis of up to >1.3 million participants, we discovered 106 new BP-associated genomic regions and 87 rare (MAF ≤ 0.01) variant BP associations (P < 5 × 10-8), of which 32 were in new BP-associated loci and 55 were independent BP-associated SNVs within known BP-associated regions. Average effects of rare variants (44% coding) were ~8 times larger than common variant effects and indicate potential candidate causal genes at new and known loci (e.g. GATA5, PLCB3). BP-associated variants (including rare and common) were enriched in regions of active chromatin in fetal tissues, potentially linking fetal development with BP regulation in later life. Multivariable Mendelian randomization suggested possible inverse effects of elevated systolic and diastolic BP on large artery stroke. Our study demonstrates the utility of rare variant analyses for identifying candidate genes and the results highlight potential therapeutic targets.

  20. Taliun, D., Harris, D.N., Kessler, M.D., Carlson, J., Szpiech, Z.A., Torres, R., …Correa, A., … Abecasis Gonçalo R. (2021). Sequencing of 53,831 diverse genomes from the nhlbi topmed program. Nature: International Weekly Journal of Science, 590(7845), 290–299. https://doi.org/10.1038/s41586-021-03205-y

    The Trans-Omics for Precision Medicine (TOPMed) programme seeks to elucidate the genetic architecture and biology of heart, lung, blood and sleep disorders, with the ultimate goal of improving diagnosis, treatment and prevention of these diseases. The initial phases of the programme focused on whole-genome sequencing of individuals with rich phenotypic data and diverse backgrounds. Here we describe the TOPMed goals and design as well as the available resources and early insights obtained from the sequence data. The resources include a variant browser, a genotype imputation server, and genomic and phenotypic data that are available through dbGaP (Database of Genotypes and Phenotypes)1. In the first 53,831 TOPMed samples, we detected more than 400 million single-nucleotide and insertion or deletion variants after alignment with the reference genome. Additional previously undescribed variants were detected through assembly of unmapped reads and customized analysis in highly variable loci. Among the more than 400 million detected variants, 97% have frequencies of less than 1% and 46% are singletons that are present in only one individual (53% among unrelated individuals). These rare variants provide insights into mutational processes and recent human evolutionary history. The extensive catalogue of genetic variation in TOPMed studies provides unique opportunities for exploring the contributions of rare and noncoding sequence variants to phenotypic variation. Furthermore, combining TOPMed haplotypes with modern imputation methods improves the power and reach of genome-wide association studies to include variants down to a frequency of approximately 0.01%.

  21. Vohra,T., Kemter, E., Sun, N., Dobenecker, B., Hinrichs, A., Burrello, J., Gomez-Sanchez, E.P., Gomez-Sanchez, C.E., Wang, J., Kinker, I., Teupser, D., Fischer, K., Schnieke, A., Peitzsch, M., Eisenhofer, G., Walch, A., Reincke, M., Wolf, E. & Williams, T.A. (2020). Effect of Dietary Sodium Modulation on Pig Adrenal Steroidogenesis and Transcriptome Profiles. Hypertension, 76(6), 1769–1777. doi: 10.1161/HYPERTENSIONAHA.120.15998.

    Primary aldosteronism is a frequent form of endocrine hypertension caused by aldosterone overproduction from the adrenal cortex. Regulation of aldosterone biosynthesis has been studied in rodents despite differences in adrenal physiology with humans. We, therefore, investigated pig adrenal steroidogenesis, morphology, and transcriptome profiles of the zona glomerulosa (zG) and zona fasciculata in response to activation of the renin-angiotensin-aldosterone system by dietary sodium restriction. Six-week-old pigs were fed a low- or high-sodium diet for 14 days (3 pigs per group, 0.4 g sodium/kg feed versus 6.8 g sodium/kg). Plasma aldosterone concentrations displayed a 43-fold increase (P=0.011) after 14 days of sodium restriction (day 14 versus day 0). Low dietary sodium caused a 2-fold increase in thickness of the zG (P<0.001) and an almost 3-fold upregulation of CYP11B (P<0.05) compared with high dietary sodium. Strong immunostaining of the KCNJ5 (G protein-activated inward rectifier potassium channel 4), which is frequently mutated in primary aldosteronism, was demonstrated in the zG. mRNA sequencing transcriptome analysis identified significantly altered expression of genes modulated by the renin-angiotensin-aldosterone system in the zG (n=1172) and zona fasciculata (n=280). These genes included many with a known role in the regulation of aldosterone synthesis and adrenal function. The most highly enriched biological pathways in the zG were related to cholesterol biosynthesis, steroid metabolism, cell cycle, and potassium channels. This study provides mechanistic insights into the physiology and pathophysiology of aldosterone production in a species closely related to humans and shows the suitability of pigs as a translational animal model for human adrenal steroidogenesis.

  22. Wingerter, K.E., O’Dell, K.R., Anglim, A.J., Bailey, A.L. Spontaneous coronary artery dissection with cardiogenic shock in the third trimester, and a successful early-term delivery: a case report. European Heart Journal- Case Reports, Volume 5, Issue 3, March 2021, ytab080, https://doi.org/10.1093/ehjcr/ytab080

    A 30-year-old woman G2P1 at Week 32 of gestation with no medical history, presented to the emergency department with severe chest pain. An electrocardiogram showed ST-segment elevation in the anterolateral leads. An emergent cardiac catheterization revealed dissection of the proximal left anterior descending (LAD) artery with TIMI (thrombolysis in myocardial infarction) 3 flow. Although initially stable, she later experienced recurrent chest pain and developed cardiogenic shock, necessitating MCS, and emergent revascularization. She was stabilized and remained closely monitored in the hospital prior to vaginal delivery at early-term.

March 2021

  1. Brooks JT, Bomar JD, Jeffords M, Farnsworth CL, Pennock AT, Upasani VV. Reliability of low dose biplanar radiography in assessing pediatric torsional pathology. J Pediatr Orthop. 2021 Jan;41(1):33-39. doi: 10.1097/BPO.0000000000001700. PMID: 33055518.

    Low-dose biplanar radiographs (LDBRs) significantly reduce ionizing radiation exposure and may be of use in evaluating lower extremity torsion in children. In this study, we evaluated how well femoral and tibial torsional profiles obtained by LDBR correspond with 3-dimensional (3D) computed tomography (CT) and magnetic resonance axial imaging (MRI) in pediatric patients with suspected rotational abnormalities. Patients who had both LDBR and CT/MRI studies performed for suspected lower extremity rotational deformities were included. Unlike previous publications, this study focused on patients with lower extremity torsional pathology, and bilateral lower extremities of 17 patients were included. CT/MRI torsion was measured using the Reikerås method, after conversion to 3D reconstructions. The LDBRs were deidentified and sent to the software division of EOS imaging, who created 3D reconstructions and evaluated each reconstruction for the torsional quantification of the femurs and tibiae. These imaging modalities were compared using correlation statistics and Bland-Altman analyses. The mean age of the cohort was 12.1±1.7 years old. Torsional values of the femur were significantly lower in LDBRs versus 3D CT/MRIs at 17.7±15.1 and 23.3±17.3, respectively (P=0.001). Torsional values of the tibia were similar in LDBRs versus 3D CT/MRIs at 23.6±10.6 and 25.3±11.2, respectively (P=0.503). There was a good intermodality agreement between LDBR and 3D CT/MRI torsional values in the femur (intraclass correlation coefficient=0.807) and tibia (intraclass correlation coefficient=0.768). Bland-Altman analyses showed a fixed bias with a mean difference of -5.6±8.8 degrees between femoral torsion measurements in LDBRs versus 3D CT/MRIs (P=0.001); 15% (5/34) of femurs had a clinically significant measurement discrepancy. Fixed bias for LDBR measurements compared with 3D CT/MRIs for the tibia was not observed (P=0.193), however, 12% (4/34) of tibias had a clinically significant measurement discrepancy. Although we found strong correlations between torsional values of the femur and tibia measured from LDBRs and 3D CT/MRIs, torsional values of the femur produced from LDBRs were significantly lower than values obtained from 3D CT/MRIs with some notable outliers.

  2. Kalin S, Dakhlalla S, Bhardwaj S. Treatment for kratom abuse in a contingency-management-based MAT setting: A case series. J Opioid Manag. 2020 Sep/Oct 2020;16(5):391-394. doi: 10.5055/jom.2020.0594. PMID: 33226096.

    Kratom (Mitragyna speciosa) is a plant extract that exhibits opioid agonistic activity at the μ-opioid receptor. The use of this substance has increased recently due to widespread local availability across the United States, primarily at gas stations. Repeated kratom use has been shown to have major adverse effects leading to physiological dependence and addiction similar to other opioids. We used a novel contingency management (CM) program utilizing nonmonetary reinforcers along with medication-assisted treatment (MAT) using buprenorphine in an office-based setting to treat kratom use disorder in two cases. MAT with buprenorphine in a CM-based setting was found to be an effective strategy for treating kratom use disorder.

  3. Lucar J, Wingler MJB, Cretella DA, Ward LM, Sims Gomillia CE, Chamberlain N, Shimose LA, Brock JB, Harvey J, Wilhelm A, Majors LT, Jeter JB, Bueno MX, Albrecht S, Navalkele B, Mena LA, Parham J. Epidemiology, clinical features, and outcomes of hospitalized adults with COVID-19: Early experience from an academic medical center in Mississippi. South Med J. 2021 Mar;114(3):144-149. doi: 10.14423/SMJ.0000000000001222. PMID: 33655307.

    The purpose of this paper is to describe the demographics, clinical characteristics, and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) in an academic medical center in the southern United States. Retrospective, observational cohort study of all adult patients (18 years and older) consecutively admitted with laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 infection between March 13 and April 25, 2020 at the University of Mississippi Medical Center. All of the patients either survived to hospital discharge or died during hospitalization. Demographics, body mass index, comorbidities, clinical manifestations, and laboratory findings were collected. Patient outcomes (need for invasive mechanical ventilation and in-hospital death) were analyzed. One hundred patients were included, 53% of whom were women. Median age was 59 years (interquartile range 44-70) and 66% were younger than 65. Seventy-five percent identified themselves as Black, despite representing 58% of hospitalized patients at our institution in 2019. Common comorbid conditions included hypertension (68%), obesity (65%), and diabetes mellitus (31%). Frequent clinical manifestations included shortness of breath (76%), cough (75%), and fever (64%). Symptoms were present for a median of 7 days (interquartile range 4-7) on presentation. Twenty-four percent of patients required mechanical ventilation and, overall, 19% died (67% of those requiring mechanical ventilation). Eighty-four percent of those who died were Black. On multivariate analysis, ever smoking (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.2-28.6) and history of diabetes mellitus (OR 5.9, 95% CI 1.5-24.3) were associated with mortality, and those admitted from home were less likely to die (vs outside facility, OR 0.2, 95% CI 0.0-0.7). Neither age, sex, race, body mass index, insurance status, nor rural residence was independently associated with mortality. Our study adds evidence that Black patients appear to be overrepresented in those hospitalized with and those who die from COVID-19, likely a manifestation of adverse social determinants of health. These findings should help guide preventive interventions targeting groups at higher risk of acquiring and developing severe COVID-19 disease.

  4. Mayer KH, Nelson L, Hightow-Weidman L, Mimiaga MJ, Mena L, Reisner S, Daskalakis D, Safren SA, Beyrer C, Sullivan PS. The persistent and evolving HIV epidemic in American men who have sex with men. Lancet. 2021 Feb 18:S0140-6736(21)00321-4. doi: 10.1016/S0140-6736(21)00321-4. Epub ahead of print. PMID: 33617771.

    Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioral issues of diverse subgroups.

  5. McDonald TC, Gnam AL, Brooks JT, Sukkarieh H, Replogle WH, Wright PB. The value-added benefit of utilizing two attending surgeons for patients with scoliosis secondary to cerebral palsy. Spine Deform. 2021 Feb 15. doi: 10.1007/s43390-021-00301-x. Epub ahead of print. PMID: 33587269.

    The use of two attending surgeons during posterior spinal fusion (PSF) for cerebral palsy (CP) patients has been shown to improve perioperative outcomes. This study aims to determine if the use of two surgeons is associated with an increase in the number of subsequent surgeries that can be performed in the same operating room (OR) during business hours. Patients with scoliosis and CP treated with PSF with minimum 90-day follow-up were included. Patients were grouped based on whether one or two attending surgeons performed the case. The primary outcome was the number of surgeries that followed in the same OR before 5 PM. Secondary outcomes included operative time, estimated blood loss (EBL), length of stay, rate of surgical site infection, and rate of unplanned return to the operating room. Thirty-six patients were included (10 with 1 surgeon and 26 with 2 surgeons). The two surgeon group had a significant increase in the average number of surgeries subsequently performed in the same OR during business hours (1.1 vs. 0.3, p = 0.01), as well as shorter mean operative time (159 vs. 307 min, p = 0.007) and EBL (554 vs. 840 cc, p = 0.01; 26 vs. 39%EBV, p = 0.03). The use of two attending surgeons was associated with a significant increase in the number of cases subsequently performed in the same OR during business hours, and significant decreases in operative time and EBL. Hospitals should consider the patient care and potential system-level improvements when considering implementation of two surgeon teams for PSF in CP patients.

  6. Ode GE, Bradford L, Ross WA, Brooks JT. Achieving a diverse, equitable, and inclusive environment for the Black orthopaedic surgeon. Part 1: Barriers to Successful Recruitment of Black Applicants. J Bone Joint Surg Am. 2020 Dec 16;Publish Ahead of Print. doi: 10.2106/JBJS.20.01768. Epub ahead of print. PMID: 33326201.

    This article serves as the first in a series exploring the barriers to achieving a diverse, inclusive, and equitable environment for Black orthopaedic surgeons. The focus of the article is to examine the barriers to successful recruitment of Black applicants and provide tangible recommendations for improving racial diversity in residency.

    Lack of racial diversity remains a persistent problem in medicine, most notably in the field of orthopaedic surgery. In 1999, an analysis by England and Pierce of orthopaedic residents who had been selected for residency programs from 1983 to 1995 found that the percentage of Blacks, Hispanics, and Native Americans had changed minimally over that 12-year period1. During that time, the rate of Black orthopaedic residents in training never surpassed 3.5%. In the >2 decades that have followed, there has been a continued call to increase recruitment of underrepresented minorities (URMs), particularly Blacks, into orthopaedic surgery2-6. Despite these directed efforts, orthopaedic surgery remains the least racially and ethnically diverse field among both surgical and nonsurgical specialties7,8. Lack of racial diversity correlates with substantial disparities in the culturally competent care of minority patients, with well-documented negative implications9-11. Improving diversity within our specialty is essential to achieving equitable postoperative and functional outcomes in our diverse patient population. While barriers to improving gender diversity have been and should continue to be explored, the profession of orthopaedic surgery must critically evaluate the barriers to recruiting URM applicants, particularly Black applicants. This is essential to help usher in the next decade with a racially diverse, inclusive, and equitable workforce.

  7. Shekhar S, Liu Y, Wang S, Zhang H, Fang X, Zhang J, Fan L, Zheng B, Roman RJ, Wang Z, Fan F, Booz GW. Novel mechanistic insights and potential therapeutic impact of TRPC6 in neurovascular coupling and ischemic stroke. International Journal of Molecular Sciences. 2021; 22(4):2074. https://doi.org/10.3390/ijms22042074

    Ischemic stroke is one of the most disabling diseases and a leading cause of death globally. Despite advances in medical care, the global burden of stroke continues to grow, as no effective treatments to limit or reverse ischemic injury to the brain are available. However, recent preclinical findings have revealed the potential role of transient receptor potential cation 6 (TRPC6) channels as endogenous protectors of neuronal tissue. Activating TRPC6 in various cerebral ischemia models has been found to prevent neuronal death, whereas blocking TRPC6 enhances sensitivity to ischemia. Evidence has shown that Ca2+ influx through TRPC6 activates the cAMP (adenosine 3’,5’-cyclic monophosphate) response element-binding protein (CREB), an important transcription factor linked to neuronal survival. Additionally, TRPC6 activation may counter excitotoxic damage resulting from glutamate release by attenuating the activity of N-methyl-d-aspartate (NMDA) receptors of neurons by posttranslational means. Unresolved though, are the roles of TRPC6 channels in non-neuronal cells, such as astrocytes and endothelial cells. Moreover, TRPC6 channels may have detrimental effects on the blood–brain barrier, although their exact role in neurovascular coupling requires further investigation. This review discusses evidence-based cell-specific aspects of TRPC6 in the brain to assess the potential targets for ischemic stroke management.

  8. Winthrop KL, Brunton AE, Beekmann S, Polgreen P, Baddley J, Saag KG, Calabrese C, Calabrese L, Robinson PC, Wallace ZS, Curtis JR; COVID-19 Study Team. SARS CoV-2 infection among patients using immunomodulatory therapies. Annals of the Rheumatic Diseases. 2021 Feb;80(2):269-271. doi: 10.1136/annrheumdis-2020-218580. Epub 2020 Aug 5. PMID: 32759259.

    The aim of this retrospective study was to analyze the risk of COVID-19 and disease progression among patients using immunomodulatory therapy. The authors implemented an active surveillance project with USA/Canada Infectious Disease specialists via the Emerging Infections Network (EIN) to identify COVID-19 cases occurring in patients who use immunomodulatory therapy up until April 2020 and to describe their clinical outcomes. Thirty-eight physicians screened over 2500 COVID-19 cases from which 77 (3%) were identified using immunomodulatory drugs. Of these, 52% were female, median age of 60 years (range, 16–84) and 83.1% had autoimmune disease. Overall, 63 (81.8%) patients were hospitalized, 27 (35.1%) required mechanical ventilation, 37 (48.1%) required ICU care and 9 (11.7%) died. While this study included relatively few biologic- or JAK inhibitor-using patients severely ill with COVID-19, no patients taking anti-TNF therapy at baseline died. This and other studies involve small numbers of patients, making further population-based studies necessary to understand the risk of DMARDs with COVID-19.

February 2021

  1. Annett R.D., Chervinskiy, S., Chun, T.H., Cowan, K., Foster, K., Goodrich, N., Hirschfeld, M., Hsia, D.S., Jarvis, J.D., Kulbeth, K., Madden, C., Nesmith. C., Raissy, H., Ross, J., Saul, J.P., Shiramizu, B., Smith, P., Sullivan, J.E., Tucker, L., Atz, A.M. (2020). IDeA states pediatric clinical trials network for underserved and rural communities. 146(4), e202000290. doi: 10.1542/peds.2020-0290. Epub 2020 Sep 17.PMID: 32943534

    The National Institutes of Health’s Environmental Influences on Child Health Outcomes (ECHO) program aims to study high priority/high-impact pediatric conditions. This broad-based health initiative is unique in the NIH research portfolio, and involves two research components: 1) a large group of established centers with pediatric cohorts combining data to support longitudinal studies (ECHO Cohorts) and 2) a pediatric trials program for institutions within IDeA states, known as the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN). The current presentation provides a broad overview of the ISPCTN and particularly its importance in enhancing clinical trials capabilities of pediatrician scientists through the support of research infrastructure, while at the same time implementing clinical trials that inform future healthcare for children. The ISPCTN research mission is aligned with the health priority conditions emphasized in the ECHO program, with a commitment to bringing state-of-the-science trials to children residing in underserved and rural communities.

    ISPCTN site infrastructure is critical to successful trial implementation and includes research training for pediatric faculty and coordinators. Network sites exist in settings that have historically had limited NIH funding success and lacked pediatric research infrastructure, with the initial funding directed to considerable efforts in professional development, implementation of regulatory procedures, and engagement of communities and families. The Network has made considerable headway with these objectives and opened two large research studies during its initial 18 months, as well as produced findings that serve as markers of success that will optimize sustainability.

  2. Chinchar, V.G., Duffus, A.L.J., and Bruner, J.L. Ecology of Viruses Infecting Ectothermic Vertebrates: The Impact of Ranavirus Infections on Amphibians. IN:  Studies in Viral Ecology, 2nd Edition (C. Hurst, ed), Wiley, 2021.

    This work is part of a collection describing the biological and ecological impacts of viral infections on various classes of animals.  While this chapter is broadly focused on viruses infecting amphibians, members of two families (Alloherpesviridae  and Iridoviridae) are dealt with in greater detail as these two appear to have the greatest impact.   The former describes the life cycle of Lucke tumor virus and its role in renal carcinoma in leopard frogs, whereas the latter focuses on the biology and immunology of members of the genus Ranavirus.  Ranaviruses infect not only amphibians, but also fish and reptile species, and are responsible for localized die-offs in nature and high levels of morbidity and mortality among cultured species.  Studies of immune responses to ranavirus infections may lead to better approaches to combat viral disease among commercially important fish and amphibian species, protection of native species, and elucidation of the origins of the vertebrate immune response. 
  1. Erickson, S.J., Hile, S., Kubinec, N., Annett, R.D. (2020). Self-reported and parent proxy functional impairment among pediatric cancer survivors and controls. Health and Quality of Life Outcomes. 18(1), 142. doi: 10.1186/s12955-020-01387-z.PMID: 32423481

    Research regarding self-reported functional impairment of cancer survivors and its association with parent-reported functional impairment and neurocognitive deficits has been limited. Our results suggest that self-reported FI appears to be a reasonable and viable outcome to measure that corresponds with and adds incremental validity to parent reported FI. While low treatment intensity may confer relative sparing of functional impairment among survivors, children report higher FI levels than parents, suggesting that FI can be of clinical utility. In conclusion, pediatric cancer survivors should be screened for self-reported functional difficulties, particularly in the areas of interpersonal relations and self-care/self-fulfillment.
  1. Karlson, C.S., Sarver, D.E., Raiker, J.S., Espil, F.M., Cox, A.D., Elkin, T.D., Annett, R.D. (2020). The contribution of neurocognitive functions to academic and psychological outcomes in pediatric cancer: A latent profile analysis. Child Neuropsychology. Mar 11:1-19. doi: 10.1080/09297049.2020.1734553

    Latent profile analysis identified discrete groups in neurocognitive functioning in this heterogeneous pediatric cancer population. Class membership was predicted by race, whole brain radiation dose, and referral source but not other medical variables (e.g., diagnosis, age at diagnosis, time since diagnosis) in our sample. Individualized neurocognitive monitoring across cancer diagnoses may be warranted to better identify children at risk for poor academic outcomes.

  2. Medina, A., Velasco Martinez, I., McIntyre, B., Chandran, R., Ameloblastoma: Clinical presentation, management and outcome. Case Reports in Plastic Surgery and Hand Surgery. v8 n1 (20210101): 27-36.

    Ameloblastoma is a benign but locally destructive lesion of the jaws that represent 10% of the odontogenic tumors. This retrospective study reports on 21 patients who underwent radical tumor excision followed by different options of immediate defect reconstruction between 2015 and 2020. We analyzed clinical presentation, preoperative assessment, options of surgical reconstruction and their indications, postoperative complications and their contributing factors and long-term outcomes. Interestingly, patients’ comorbidities, chronic use of medications, chronic consumption of alcohol and/or tobacco and BMI status did not contribute to the development of postoperative complications or increase hospital stay. By contrast, the presence of giant ameloblastoma (≥5cm) and/or tumor involving bony curvatures not only increased the complexity of the procedure for contour reconstruction, but they also presented a statistically significant higher incidence of postoperative complications (P-value of 0.04). Furthermore, the presence of giant tumors and use of fibula free flap significantly prolonged the length of stay (P-values of 0.02 and 0.001, respectively). All patients recovered without major limitations. The incorporation of dental implants and inferior alveolar nerve restoration have increased our functional outcomes and patients’ satisfaction.

    The management of ameloblastomas requires a multidisciplinary team with experience in ablative and reconstructive surgeries, oral rehabilitation (i.e., dental implants, speech, etc.) as well as managing the social and emotional aspects of this disease. A long-term commitment and collaborative effort from the team as well as patients and their families are crucial to optimize results.

  3. Medina, A., Velasco Martinez, I., Nguyen, Q.C. Immediate allograft reconstruction of the infraorbital nerve following resection of polyostotic fibrous dysplasia lesion. Case Reports in Plastic Surgery and Hand Surgery. v8 n1 (20210101): 12-17.

    Processed nerve allografts (PNA) have increasingly been used as alternative to autogenous nerve grafts to repair nerve injuries in oral-maxillofacial surgeries. This case report describes an immediate PNA reconstruction of infraorbital nerve injury sustained during the ablation of a large expansile polyostotic fibrous dysplasia centered in the left maxilla.

  4. Medina, A., Songcharoen, S., Velasco Martinez, I. (2021). Management of posterior maxillary ameloblastoma with scapular tip free flap. Ann Case Reports 6(1):1-5. DOI: 10.29011/2574-7754.100574

    Maxillary ameloblastomas are rare odontogenic epithelial tumors predominantly located in the posterior segment of the maxilla. Due to their anatomical confinement and difficulties for successful resection, these tumors show high risk of postoperative complications and recurrence. The reconstruction with vascularized bone grafts appears to be a reasonable option for optimal cosmetic and functional results. We present a case of maxillary ameloblastoma located at molar region treated with extensive resection and scapular tip free flap.

  5. Sullivan, K.J., Ranadive, R., Su, D., Neyland, B.R., Hughes,T.M., Hugenschmidt, C.E., Lockhart, S.N., Wong, D.F., Jack, C.R., Gottesman, R.F., Mosley, T.H., Griswold, M.E., Windham, B.G. Imagine-based indices of neuropathology and gait speed decline in older adults: The atherosclerosis risk in communities study. Brain Imaging and Behavior (2021) 1-10.

    Imaging markers of cerebrovascular disease and Alzheimer’s disease (AD) are implicated in mobility impairment in older adults, but few studies have examined these relationships longitudinally in a racially-diverse population-based sample. At Visit 5 (2011-13) of the Atherosclerosis Risk in Communities Study, 1859 participants had usual pace gait speed (cm/s) assessed and brain MRI (mean age=76.3, 28.5% Black) and PET (n=343; mean age=75.9, 42.6% Black) measures including total/regional brain volume (cm3), white matter hyperintensities (WMH; cm3), infarcts (present/absent), microbleeds (count) and global beta-amyloid (Aβ). Participants returned at Visit 6 (n=1264, 2016-17) and Visit 7 (n=1108, 2018-19) for follow-up gait speed assessments. We used linear regression to estimate effects of baseline infarct presence, higher microbleed count, and a one interquartile range (IQR) poorer measures of continuous predictors (-1 IQR total brain volume, temporal-parietal lobe meta region of interest(ROI); +1 IQR WMH volume, global Aβ SUVR) on cross-sectional gait speed and change in gait speed adjusting for age, sex, education, study site, APOE e4, estimated intracranial volume, BMI, and cardiovascular risk factors. Cross-sectionally, slower gait speed outcome was associated with higher WMH volume, -3.38 cm/s (95%CI:-4.71, -2.04), infarct presence, -5.60 cm/s (-7.69, -3.51), microbleed count, -2.20 cm/s (-3.20, -0.91), smaller total brain volume, -9.26 cm/s (-12.1, -6.43), and smaller temporal-parietal lobe ROI -6.28 cm/s (-8.28, -4.28). Longitudinally, faster gait speed outcome decline was associated with higher WMH volume, -0.27 cm/s/year, (-0.51, -0.03) and higher global Aβ SUVR, -0.62 cm/s/year (-1.20, -0.03). Both cerebrovascular and AD pathology may contribute to mobility decline commonly seen with aging.

  6. Tankersley, A., Velasco Martinez, I., Medina, A. (2020). Use of cervicothoracic rotation flap and osteocutaneous radial forearm free flap for a complex multilayered cheek defect reconstruction. Case Reports Plastic Surgery and Hand Surgery. 7(1): 98-104. PMID: 3293964

    We report the combination of osteocutaneous radial forearm free flap and extensive cervicothoracic flap to reconstruct a large through-and-through cheek and mandibular defect. In patients with difficult clinical settings, this approach reduces operative time and complications without compromising the functional and cosmetic outcomes.

  7. Teachey, D.T., Devidas, M., Wood, B.L., Chen, Z., Hayashi, R.J., Annett, R.D., Asselin, B.L., August, K.J., Cho, S.Y., Dunsmore, K.P., Fisher, B.T., Freedman, J.L., Galardy, P.J., Harker-Murray, P., Hermiston, M.L., Horton, T.M., Jaju, A.I., Lam, A., Messinger, Y.H., Miles, R.R., Okada, M., Patel, S.I., Schafer, E.S., Schechter-Finkelstein, T., Shimano, K.A., Singh, N., Steele, A.C., Sulis, M.L., Vargas, S.L., Winter, S.S., Wood, C., McKay, P.Z., Bollard, C.M., Loh, M.L., Hunger, S.P., Raetz, E.A. (2020). Cranial radiation can be eliminated in most children with t-cell acute lymphoblastic leukemia (T-ALL) and bortezomib potentially improves survival in children with t-cell lymphoblastic lymphoma (T-LL): Results of Children's Oncology Group (COG) Trial AALL1231. Blood. 136 (Supplement 1): 11–12. doi.org/10.1182/blood-2020-134730

    Outcomes for standard risk (SR) and intermediate risk (IR) pts with T-ALL and T-LL treated with bortezomib were excellent despite the elimination of prophylactic CXRT. Bortezomib significantly improved 3-year EFS for these groups, comprising ~95% of pts. Outcomes for very high risk (VHR) pts were dismal and worse on the bortezomib arm. T-LL pts had significantly improved EFS and OS with bortezomib on the AALL1231 backbone. This is the first trial to demonstrate an OS benefit for de novo pediatric T-LL with a new agent; however, longer follow-up is needed. Therapy intensification allowed elimination of CXRT in the majority of pts without excessive relapse. These results should be interpreted cautiously as the 3-yr OS on AALL1231 was inferior to AALL0434. Nevertheless, incorporating bortezomib into standard therapy for de novo T-LL appears advantageous. Future COG T-ALL/T-LLy trials will build on the positive findings from AALL0434 and AALL1231, balancing intensity while mitigating toxicity to maintain high cure rates without routine cranial radiation.

  8. Thekkeveedu, R.K., Ramarao, S., Dankhara, N. and Alur, P. Hypochloremia secondary to diuretics in preterm infants: Should clinicians pay close attention? Global Pediatric Health. v8: 1–10. DOI: 10.1177/2333794X21991014

    Diuretic therapy, commonly used in the newborn intensive care unit, is associated with a variety of electrolyte abnormalities such as hyponatremia, hypokalemia, and hypochloremia. Hypochloremia, often ignored, is associated with significant morbidities and increased mortality in infants and adults. Clinicians respond in a reflex manner to hyponatremia than to hypochloremia. Hypochloremia is associated with nephrocalcinosis, hypochloremic alkalosis, and poor growth. Besides, the diuretic resistance associated with hypochloremia makes maintaining chloride levels in the physiological range even more logical. Since sodium supplementation counters the renal absorption of calcium and lack of evidence for spironolactone role in diuretic therapy for bronchopulmonary dysplasia (BPD), alternate chloride supplements such as potassium or arginine chloride may need to be considered in the management of hypochloremia due to diuretic therapy. In this review, we have summarized the current literature on hypochloremia secondary to diuretics and suggested a pragmatic approach to hypochloremia in preterm infants.

  9. Young, L.W., Hu, Z., Annett, R.D., Das, A., Fuller, J.F., Higgins, R.D., Lester, B.M., Merhar, S.L., Simon, A.E., Ounpraseuth, S., Smith, P.B., Crawford, M.M., Atz, A.M., Cottrell, L.E., Czynski, A.J., Newman, S., Paul, D.A., Sanchez, P.J., Semmens, E.D., Smith, C., Turley, C.B., Whalen, B.L., Poindexter, B.B., Snowden, J.N., Devlin, L.A. (2021). Site-level variation in the characteristics and care of infants with neonatal opioid withdrawal. Pediatrics. 147(1), e2020008839. doi: 10.1542/peds.2020-008839. Epub 2020 Dec 21.PMID: 33386337

    Variation in healthcare contributes to discrepancies in outcomes. Understanding this variation is critical. Multiple factors contribute to the potential for site-level variation to exist in the characteristics, care, and outcomes of infants with NOWS, but current supportive literature is limited.  We observed substantial site-to-site variation in maternal-infant characteristics, infant management, and outcomes for infants with NOWS.  For example, rates of maternal medication assisted treatment, infant pharmacologic treatment, and length of stay for infants with NOWS varied widely across sites.

January 2021

  1. Auchus, A., Brodell, R.T., Nahar, V.K., Ward, K.H. Avoiding the hazards of ultraviolet light in the adolescent population. SKIN:The Journal of Cutaneous Medicine. 4(3), 189-199.

    Exposure to UV light remains the major modifiable risk factor for skin cancer. Studies have shown that adolescents do not adequately use sun protection and frequently engage in tanning behaviors. This article will reinforce the known approaches to avoiding the hazards of UV light and provide tips and tricks that health care providers should emphasize to their adolescent patients. These include use of SPF 30 or greater sunscreen, wearing appropriate hats and cover-up clothing, avoiding the environmental UV when it is most intense, and avoiding tanning parlors.

  2. Auchus, A., Brodell, R.T., Nahar, V.K., Ward, K.H. Commentary in response to: Commentary on “Avoiding the hazards of ultraviolet light in adolescent population.” Skin:The Journal of Cutaneous Medicine. 4(5): pages pending (September 2020).

    A letter to the editor was submitted by Weisert and Hinds regarding our recent publication “Avoiding the Hazards of Ultraviolet Light in the Adolescent Population.”  They referred to emerging evidence on the effects of visible light on premature aging and proposed a need for utilizing a topical antioxidant serum in addition to daily sunscreen. We responded that our article discussed the “standard of care” in 2020 and there is risk in recommending approaches that are not yet proven and in diluting our simple message: Wear a hat, use sunscreen, and sit under cover especially during mid-day.

  3. Bhate, C., Ho, C.H., Brodell, R.T. Time to revisit the Health Insurance Portability and Accountability Act (HIPAA)? Accelerated telehealth adoption during the COVID-19 pandemic. Journal of the American Academy of Dermatology. 2020;83(4):e313-e314.

    Throughout the coronavirus disease 2019 (COVID-19) pandemic, campaigns to promote social distancing and sheltering-in-place in the United States forced most dermatology offices to change the way they operate. These measures, combined with a temporary easing of the enforcement of the Health Insurance Portability and Accountability Act (HIPAA) for telehealth during the public health emergency, motivated dermatologists to embrace teledermatology in all its forms. Despite the return of in-office evaluation, telemedicine will likely remain a part of our new normal.

  4. Bhatia, K., Brodell, R.T., Bhatia, A.C., Mockbee, C.S. Interdigital Tinea: The forerunner of infectious eczematoid dermatitis. SKIN:The Journal of Cutaneous Medicine. Accepted May 1, 2020.

    A case of infectious eczematoid dermatitis is presented.  This distinct from of auto-eczematization (dermatophytid or id reaction) when drainage from a localized bacterial process produces an allergic contact dermatitis. Diagnosis and treatment are discussed.

  5. Brodell, R.T., Jackson, J.D., Grant-Kels, J.M. The ethics of service as a department chairperson &/or residency director. In Bercovitch, L., Perlis, C., Stoff, B., Grant-Kels, J.M. Dermatoethics: Contemporary Ethics and Professionalism in Dermatology. London (Springer). Accepted May 25, 2020.

    This book chapter reviews the myriad of ethical dilemmas encountered by the department chairperson or residency program director to prepare young leaders for the challenges that await them.

  6. Brumfield, C.M., Jefferson, I.S., Wu, A.G., Strunck, J.L., Veerabagu, S., Lin, K., Brodell, R.T., Rosman, I.S. Research Letter: A national webinar for dermatology applicants during the COVID-19 pandemic. Journal of the American Academy of Dermatology. Accepted September 14, 2020

    Drastic adjustments to medical education during the COVID-19 pandemic left medical students concerned about changes to the residency application process. Elimination of in-person away rotations, delayed or cancelled sub-internships, and transition to virtual interviews are among the difficulties faced by dermatology applicants this cycle. The Association of Professors of Dermatology (APD) and the national Dermatology Interest Group Association (DIGA) representing 120 medical school chapters hosted a webinar for dermatology residency hopefuls titled ‘The Shifting Landscape of the 2020- 2021 Dermatology Application Cycle in the Era of the COVID-19 Pandemic.’ An optional poll for medical student attendees was administered.  It focused on questions collected from medical students via Google questionnaires prior to the event. A total of 996 viewers attended the webinar. The broad adoption of video conference communication during the COVID-19 pandemic produced into unique opportunities for medical students to stay informed on issues of significant value to them. The large number of webinar viewers suggests acute interest in this format and led to another national webinar on virtual interviews held this fall. Beyond COVID-19 and the resumption of the traditional residency application process, large-scale webinars may continue to be invaluable resources for dermatology applicants.

  7. Burns, P.A., Omondi, A.A., Monger, M., Ward, L., Washington, R., Sims Gomillia, C.E., Bamrick-Fernandez, D.R., Anyimukwu, C., Mena, L.A. Meet me where I am: An evaluation of an HIV patient navigation intervention to increase uptake of PrEP among Black men who have sex with men in the deep south. Journal Racial Ethnic Health Disparities. 2021 Jan 5. doi: 10.1007/s40615-020-00933-1. Online ahead of print. PMID: 33403654

    The southern region of the USA is the epicenter of the HIV epidemic. HIV disproportionately affects African Americans, particularly Black men who have sex with men (Black MSM). Given the alarming rates of new infections among Black MSM, there is an urgent need for culturally competent healthcare professionals who are trained to address the unique needs and barriers to uptake and adherence to HIV prevention, care, and treatment services. Utilizing a mixed method research approach, we conducted a process evaluation of Meet Me Where I Am, a 6-month, 6-session HIV/AIDS patient navigation training program for healthcare professionals and patient navigators working in organizations that provide HIV services to residents of central Mississippi, an area with high incidence and prevalence rates of HIV. A self-administered questionnaire after each session was given to participants to assess the acceptability, quality, and translational aspects of the training program. The overall positive feedback on the MMWIA training reflects the program's acceptability and feasibility. Participants found that the training was effective in providing the necessary knowledge and skills to deliver patient-centered HIV prevention-related navigation services. A majority (67%) of participants indicated that they felt they could apply the lessons learned within their healthcare settings to improve access to HIV prevention, care, and treatment services. If we are to reduce racial and ethnic disparities in HIV/AIDS, there is a critical need for culturally appropriate training programs designed to improve the ability of healthcare professionals and health systems to deliver culturally competent HIV prevention, care, and treatment services.

  8. Davis, R.E., Bass, M.A., Wade, M.A,, Nahar, V.K. Screening for depression among a sample of US college students who engage in recreational prescription opioid misuse. Health Promotion Perspectives. 2020;10(1):59-65.

    Among student populations, literature has identified associations between prescription opioid misuse and symptoms of depression such as hopelessness, sadness, and emotional pain. Thus far, existing literature has yet to investigate associations between prescription opioid misuse and depression using validated screening instruments for depression when exploring such associations. The purpose of this study was to utilize a validated screening tool to explore quantifiable presence of depression among college students who engage in recreational prescription opioid misuse (RPOM). Additionally, gender differences in depression and co-occurring substance use are examined.

  9. Davis, R.E., Doyle, N.A., Nahar, V.K. Association between prescription opioid misuse and dimensions of suicidality among college students. Psychiatry Research. 2020;287:112469.

    Suicide rates among young adults have increased in recent years. Prescription opioid misuse is not only associated with depression onset but misuse has also been reported as means to manage existing depressive symptoms. College students are at increased risk for psychological distress compared to other populations. The current cross-sectional study aimed to fill a literature gap by examining a relationship between prescription opioid misuse and 3 dimensions of suicidality among a large sample of college students (n = 889).

  10. Douglas, K.D., Smith, K.K., Stewart, M.W., Walker, J., Mena, L., Zhang, L. Exploring parents' intentions to monitor and mediate adolescent social media use and implications for school nurses. The Journal of School Nursing. 2020 Dec 30:1059840520983286. doi: 10.1177/1059840520983286. Online ahead of print. PMID: 33375901

    Social media may promote health and social connectedness, but its misuse and frequency of use may pose risks. Social media use during adolescence requires parental monitoring and mediation to mitigate potentially harmful effects such as depression, anxiety, and risk-taking behaviors. While parents and health care professionals convey concern surrounding exposure to inappropriate content, prolonged screen time, and cyberbullying, appropriate social media monitoring remains challenging. The purpose of this study was to explore parental monitoring and mediation of social media use in adolescents. Online recruitment yielded a nationwide sample (n = 836) of parents of adolescents. The results of the online survey indicated that parents are concerned about adolescent social media use and endorse positive attitudes toward monitoring. Yet parents perceived little control over monitoring. Findings from this study support the school nurse in promoting healthy social media use, media literacy among parents and adolescents, and the use of screening tools.

  11. Gomillia, C.E.S., Backus, K.V., Brock, J.B., Melvin, S.C., Parham, J.J., Mena, L.A. Rapid antiretroviral therapy (ART) initiation at a community-based clinic in Jackson, MS. AIDS Research and Therapy. 2020 Oct 8;17(1):60. doi: 10.1186/s12981-020-00319-7. PMID: 33032617

    Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

  12. Harrington, H., Pearlman, R.L., Brodell, R.T. A new-onset, suspicious skin lesion (tick). The Journal of Urgent Care Medicine. Accepted August 30, 2020.

    Ticks are small—so small that patients often do not feel their bite or sense their presence once it is attached. As such, attached ticks can be mistaken by patients as “new moles.” The diseases they carry, including Lyme disease, Rocky Mountain spotted fever, tularemia, and ehrlichiosis, cause significant morbidity and mortality. It is important that physicians recognize and remove ticks promptly to decrease the potential for disease transmission. Here, we present a case of a tick mistaken for a growing pigmented lesion.

  13. Helling, T.S. A cold and drowsy humor”: Theories of traumatic shock from Bernard to Laborit. Journal of Trauma and Acute Care Surgery: September 2020 - Volume 89 - Issue 3 - p e41-e47 doi: 10.1097/TA.0000000000002826

    The specter of traumatic shock continues to plague modern military surgeon as a manifestation of a physiology dangerously close to irreversible cardiovascular changes intent on imperiling the victim. Few doubted the primacy of blood loss as etiology, but other disturbances were suspected. Complete understanding eluded the most cogent of investigators. It was inescapable that perturbations of the involuntary (autonomic) nervous system and its regulation of vasomotor function substantially contributed to observable derangements. Whether manipulation of this nervous network could alter the progression of shock has been a target of experimentation for the past century. At the heart of investigation was the pivotal experimental work of Claude Bernard, who demonstrated a vegetative neural responsiveness that bled into his defining concept of the milieu intérieur and the innate organic endeavor to maintain internal constancy. This work will address efforts by numbers of his followers to unravel the mysteries of the autonomic (vegetative) nervous system and its humoural agents of facilitation instrumental in shock’s lethal potential. Efforts to identify substances that affect nerve transmission culminated in the trials of a hitherto obscure French military surgeon by the name of Henri Laborit and his iconoclastic attempts to introduce novel treatment paradigms – including the use of, what he would call, artificial hibernation – to avert this perilous clinical syndrome.

  14. Hodge, B.D., Brodell, R.T. Anatomy, Skin Sweat Glands. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 16, 2020.

    Sweat glands are appendages of the integument. There are eccrine and apocrine sweat glands. They differ in embryology, distribution, and function. Eccrine sweat glands are simple, coiled, tubular glands present throughout the body, most numerously on the soles of the feet. Thin skin covers most of the body and contains sweat glands, in addition to hair follicles, hair arrector muscles, and sebaceous glands. Given the role of sweat glands in thermoregulation, both eccrine and apocrine glands have correlations with various diseases ranging from mild and discomforting to life-threatening. Disorders of sweating can have emotional, social, and professional implications.

  15. Klausner, J.D., Bristow, C.C., Soge, O.O., Shahkolahi, A., Waymer, T., Bolan, R.K., Philip, S.S., Asbel, L.E., Taylor, S.N., Mena, L.A., Goldstein, D.A., Powell, J.A., Wierzbicki, M.R., Morris, S.R. Resistance-guided treatment of gonorrhea: A prospective clinical study. Clinical Infectious Diseases. 2020 Aug 7:ciaa596. doi: 10.1093/cid/ciaa596. Online ahead of print. PMID: 32766725

    Novel treatment strategies to slow the continued emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae are urgently needed. A molecular assay that predicts in vitro ciprofloxacin susceptibility is now available but has not been systematically studied in human infections. Using a genotypic polymerase chain reaction assay to determine the status of the N. gonorrhoeae gyrase subunit A serine 91 codon, we conducted a multisite prospective clinical study of the efficacy of a single oral dose of ciprofloxacin 500 mg in patients with culture-positive gonorrhea. Follow-up specimens for culture were collected to determine microbiological cure 5-10 days post-treatment. Of the 106 subjects possessing culture-positive infections with wild-type gyrA serine N. gonorrhoeae genotype, the efficacy of single-dose oral ciprofloxacin treatment in the per-protocol population was 100% (95% 1-sided confidence interval, 97.5-100%). Resistance-guided treatment of N. gonorrhoeae infections with single-dose oral ciprofloxacin was highly efficacious. The widespread introduction and scale-up of gyrA serine 91 genotyping in N. gonorrhoeae infections could have substantial medical and public health benefits in settings where the majority of gonococcal infections are ciprofloxacin susceptible.

  16. Kurnutala, L.N., Anand, S. (August 05, 2020) Perioperative stroke in a patient undergoing noncardiac, non-neurosurgical procedure: A case report. Cureus 12(8): e9570. doi:10.7759/cureus.9570

    Perioperative stroke is a focal or global neurological deficit lasting more than 24 hours, which occurs during the surgery or within 30 days following surgery. Medications administered during anesthesia mask the symptoms of stroke in the perioperative period and make the early diagnosis of stroke difficult. Postoperative endothelial dysfunction and surgery-induced hypercoagulable state are some of the factors contributing to perioperative stroke. This report describes a case of perioperative stroke in a patient with an unremarkable intraoperative course following otolaryngology surgery. Vigilance, early diagnosis, and prompt treatment with the help of the acute stroke team are pivotal in improving patient outcomes.

  17. Kurnutala, L.N., Rugnath, N. (September 29, 2020) Pseudocholinesterase deficiency – Is succinylcholine still needed to facilitate endotracheal intubation? Cureus 12(9): e10721.

    Pseudocholinesterase (butyrylcholinesterase) deficiency is an inherited or acquired condition in which the serum pseudocholinesterase levels are absent or lower than normal. The enzyme is produced by the liver; decreased levels of the enzyme in an individual cause increased sensitivity to anesthetic agents, like succinylcholine and mivacurium. Pseudocholinesterase deficiency is caused by butyrylcholinesterase (BCHE) gene mutation, a gene that provides instructions for making the pseudocholinesterase enzyme. Succinylcholine is a depolarizing muscle relaxant that provides a quicker onset and a brief duration of muscle relaxation during general anesthesia. In this article, we would like to discuss a case report of prolonged intubation and ventilation in a patient with pseudocholinesterase deficiency and the necessity of succinylcholine during intubation in comparison to possible alternatives (rocuronium).

  18. Kurnutala, L.N., Strother, A.W., Hierlmeier, B.J. Incidental finding of tracheobronchial foreign body during double lumen tube placement-lessons learned. Saudi Journal of Anesthesia, 2020;14:514-6

    Tracheobronchial foreign bodies are common in pediatric patients, but also seen in adult patients. Most of these patients present with history of foreign body inhalation, or with the symptoms like cough, respiratory distress. In this paper, we would like to report an incidental finding of a tablet in tracheobronchial tree during double lumen tube placement with fiberoptic bronchoscopy in a middle-aged patient scheduled for right lung decortication for hemothorax. We also learned that delay in removing the tablet would make the removal of foreign body complicated. The patient did not report any history of aspiration or have any signs and symptoms consistent with aspiration. We also discussed the difficult in diagnosing foreign-body aspiration in adults with nonspecific symptoms.

  19. Momah, T., Thomas, K., Van, VI L. A painful buttock mass resulting from metastatic lung cancer. International Journal of Research Studies in Medical and Health Sciences. Volume 5, Issue 12, 2020, PP 24-26

    A 59 year old African American male with past medical history of hypertension, hyperlipidemia, cerebrovascular accident, and nicotine dependence (47-pack-years) presented to the emergency room (ER) for complaints of left gluteal mass for two months. The mass was associated with a dull, aching pain, and was progressively increasing in size.

  20. Morris, S.R., Bristow, C.C., Wierzbicki, M.R., Sarno, M., Asbel, L., French, A., Gaydos, C.A., Hazan, L., Mena, L., Madhivanan, P., Philip, S., Schwartz, S., Brown, C., Styers, D., Waymer, T., Klausner, J.D. Performance of a single-use, rapid, point-of-care PCR device for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: A cross-sectional study. The Lancet Infectious Diseases. 2020 Nov 23:S1473-3099(20)30734-9. doi: 10.1016/S1473-3099(20)30734-9. Online ahead of print. PMID: 33242473

    Timely detection and treatment are important for the control of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. The objective of this study was to measure the performance of the Visby Medical Sexual Health Test, a single-use, point-of-care PCR device. Women aged 14 years and older who presented consecutively to ten clinical sites across seven US states were enrolled for a cross-sectional, single-visit study. Patients who consented to participate, and who had not used any exclusionary products in the genital area in the previous 48 h, provided self-collected vaginal swabs for testing with the investigational device. Untrained operators received the specimens and ran the device using the guide provided. Specimens had to be run within 2 h of collection to be considered valid. For comparison, patient-infected status was derived by testing clinician-collected vaginal specimens with the Hologic Aptima Combo 2 Assay and Aptima Trichomonas vaginalis Assay, as well as the BD ProbeTec CT/GC Qx Amplified DNA Assay and BD ProbeTec Trichomonas vaginalis Qx Assay. If the results of those assays did not match, the BD MAX CT/GC/TV was used as a tiebreaker. The primary outcomes were the sensitivity and specificity of the investigational device for the detection of C trachomatis, N gonorrhoeae, and T vaginalis compared with patient-infected status. Between Feb 25, 2019, and Jan 6, 2020, 1585 participants aged between 14 years and 80 years (mean 34·8 [SD 14·2]) were enrolled. 1555 participants had tests run with the investigational device, of whom 1532 (98·5%) had a valid result on either the first or repeat test. Among the patients with evaluable results (including a determinate patient-infected status), the device had a sensitivity of 97·6% (95% CI 93·2-99·2) and specificity of 98·3% (97·5-98·9) for C trachomatis (n=1457), sensitivity of 97·4% (86·5-99·5) and specificity of 99·4% (98·9-99·7) for N gonorrhoeae (n=1468), and sensitivity of 99·2% (95·5-99·9) and specificity of 96·9% (95·8-97·7) for T vaginalis (n=1449). This innovative, rapid, easy-to-use, single-use, point-of-care device to detect C trachomatis, N gonorrhoeae, and T vaginalis infections showed excellent sensitivity and specificity, and could represent an important advance in the development of rapid diagnostics for sexually transmitted infections and other infectious diseases.

  21. Nahar, V.K., Wilkerson, A.H., Mayer, J.E., et al. Attitudes and practice among dermatologists regarding indoor tanning. Archives of Dermatological Research. 2020; 312(9):681-684.

    The aim of this study was to explore dermatologists' practices and attitudes related to educating and counseling their adolescent patients about indoor tanning. An online survey was carried out with a convenience sample of 100 dermatologists. Findings indicated that the majority of the dermatologists are actively engaged in discussing tanning bed use and sun protection with their adolescent patients. Most expressed positive attitudes toward educating patients on the risks of tanning bed use. Limited time was the most commonly reported barrier for the lack of discussion regarding indoor tanning. Of note, more than half of the dermatologists (65 percent) had patients suffering from tanning addiction. For tanning-addicted patients, dermatologists can encourage lifestyle changes, the use of sunless tanning products, and referrals when the patient's needs extend beyond the scope of the dermatologist.

  22. Nahar, L., Brodell, R.T. Transient, pruritic linear eruption on the arms. The Journal of the Dermatology Nurses' Association, 12(3), 133-134.

    A teledermatology case is presented highlighting the linear appearance of dermatographism and discussing the differential diagnosis and treatment.

  23. Nahar, V.K., Wilkerson, A.H., Pearlman, R.L., et al. Skin cancer-related knowledge, attitudes, beliefs, and practices among the population in Gulf Cooperation Council countries: A systematic search and literature review. Archives of Dermatological Research. 2020;312(8):533-544.

    Skin cancers are the most common malignancies diagnosed worldwide. In Gulf Cooperation Council (GCC) countries, skin cancer remains a significant health burden. Multiple studies have attempted to elucidate patient knowledge and attitudes regarding skin cancer risks and behavioral interventions to reduce risks. A systematic literature search of relevant articles was conducted in PubMed, ScienceDirect, and the Saudi Digital Library databases. A narrative analysis of relevant study results was conducted. A total of 12 studies were reviewed across GCC. These studies revealed common themes among GCC populations. Many study participants were aware that excess sun exposure represents a threat to health and increases cancer risk. Several studies reported sun exposure, with a mean of 19.13 h per week. More studies reported patients engaging in lower or no sunscreen use rather than regular sunscreen use. There are discrepancies in the understanding of sun exposure risk and risk mitigation practices among the study populations. Skin cancer poses a significant burden to patients in GCC countries and improved patient education will enhance population health.

  24. Patel, F.C., Raines, J.A., Kim, R.W., Gruszynski, K., Davis, R.E., Sharma, M., Patterson, G., Johnson, J.W., Nahar, V.K. Veterinarians' attitudes and practices regarding opioid-related vet shopping practices in tri-state Appalachian counties: An exploratory study. BMC Veterinary Research. 2020;16(1):210.

    The opioid crisis continues to grow in the United States with 46,700 drug overdose deaths due to opioids in 2017 alone. Vet shopping, the practice of soliciting veterinarians for prescription medications, has been receiving national media attention in recent years. A 2014 review of Prescription Monitoring Drug Programs found less than 10 veterinary shoppers nationwide. Still much is unknown about the role of vet shopping and the opioid crisis. This study sought to understand the practice of vet shopping through the eyes of veterinarians practicing in Appalachian counties within the states of Kentucky, Tennessee, and Virginia, United States.

  25. Pearlman, R.L., Patel, V., Davis, R.E., et al. Effects of health beliefs, social support, and self-efficacy on sun protection behaviors among medical students: Testing of an extended health belief model [published online ahead of print, 2020 Aug 11]. Archives of Dermatological Research. 2020;10.1007/s00403-020-02123-9.

    Sun protection behaviors (SPB) are important modifiable risk factors for skin cancer. As the most common malignancies in the world, skin cancers account for significant morbidity, mortality, and economic burden. Physicians play a key role in educating patients about proper SPB. Medical education provides the foundation for physician understanding of SPB and future patient education. The Health Belief Model (HBM) is a theoretical model that offers constructs to help explain health behaviors. This cross-sectional study examined a convenience sample of 186 medical student to assess their engagement in SPB through the lens of the 6 HBM constructs and social support. Overall, we found engagement in SPB among our cohort to be low. About 70.4% report never using wide-brimmed hats and only 44.6% often or always use sunscreen. Hierarchical multiple regressions were performed in three blocks to analyze the relationship between the independent variables (HBM constructs and social support) and dependent variable (SPB) after controlling for the influence of demographic covariates. In our health constructs model, beliefs about susceptibility, benefits minus barriers, and self-efficacy were found to be significant predictors of engaging in SPB. Addition of social support in the final model did not significantly improve prediction of SPB engagement. These findings support use of educational programs based on HBM for the improvement of SPB among medical students.

  26. Rodriguez-Diaz, C.E., Guilamo-Ramos, V., Mena, L., Hall, E., Honermann, B., Crowley, J.S., Baral, S., Prado, G.J., Marzan-Rodriguez, M., Beyrer, C., Sullivan, P.S., Millett, G.A. Risk for COVID-19 infection and death among Latinos in the United States: Examining heterogeneity in transmission dynamics. Annals of Epidemiology. 2020 Dec;52:46-53.e2. doi: 10.1016/j.annepidem.2020.07.007. Epub 2020 Jul 23. PMID: 32711053

    The purpose of this study was to ascertain COVID-19 transmission dynamics among Latino communities nationally. We compared predictors of COVID-19 cases and deaths between disproportionally Latino counties (≥17.8% Latino population) and all other counties through May 11, 2020. Adjusted rate ratios (aRRs) were estimated using COVID-19 cases and deaths via zero-inflated binomial regression models. COVID-19 diagnoses rates were greater in Latino counties nationally (90.9 vs. 82.0 per 100,000). In multivariable analysis, COVID-19 cases were greater in Northeastern and Midwestern Latino counties (aRR: 1.42, 95% CI: 1.11-1.84, and aRR: 1.70, 95% CI: 1.57-1.85, respectively). COVID-19 deaths were greater in Midwestern Latino counties (aRR: 1.17, 95% CI: 1.04-1.34). COVID-19 diagnoses were associated with counties with greater monolingual Spanish speakers, employment rates, heart disease deaths, less social distancing, and days since the first reported case. COVID-19 deaths were associated with household occupancy density, air pollution, employment, days since the first reported case, and age (fewer <35 yo). COVID-19 risks and deaths among Latino populations differ by region. Structural factors place Latino populations and particularly monolingual Spanish speakers at elevated risk for COVID-19 acquisition.

  27. Santos, C.D.S.E., Filho, L.M.D.C.L., Santos, C.A.T., Neill, J.S., Vale, H.F., Kurnutala, L.N. Pituitary tumor resection in a patient with SARS-CoV-2 (COVID-19) infection. A case report and suggested airway management guidelines. Revista brasileira de anestesiologia (Translation: Brazilian Journal of Anesthesiology). 2020;70(2):165-170.

    The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year-old male COVID-19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention.

  28. Sharma, M., Batra, K., Nahar, V.K. (2020). Alcohol consumption in COVID-19 pandemic: Implications for alcohol education. Journal of Alcohol and Drug Education, 64(2), 8-19.

    The COVID-19 pandemic is affecting all spheres of life worldwide. Besides health, the social and economic consequences of COVID-19 altered patterns of alcohol consumption, which warrants further elucidation. This commentary addresses the implications of COVID-19 on alcohol use and alcohol education. Alcohol drinking is a modifiable risk factor that increases the susceptibility and adverse consequences in COVID-19 patients. There is a bidirectional relationship between CO VID-19 and alcohol-related problems. Alcohol use, especially heavy drinking, lowers the body s immunity to fight infections. One of the effects of COVID-19 has been the enforcement of lockdowns as part of community-wide quarantine. There are differing reports about the impact of lockdowns on alcohol use. In the short term, generally decreased use and the manifestation of withdrawal symptoms in those suffering from alcohol use disorder have been noted. In the long term, due to distress and negative psychological sequelae associated with isolation, increased use is reported. Also, the myth of the preventive role of consuming alcohol in COVID-19 has resulted in adverse consequences including deaths in many parts of the world. This commentary advocates for the implementation of theory-based educational programs at primary, secondary, and tertiary levels to reduce alcohol use in the COVID-19 era.

  29. Sharma, M., Largo-Wight, E., Kanekar, A., Kusumoto, H., Hooper, S., Nahar, V.K. Using the multi-theory model (MTM) of health behavior change to explain intentional outdoor nature contact behavior among college students. International Journal of Environmental Research and Public Health. 2020; 17(17):E6104.

    Nature contact is an emerging health behavior and is defined as the interaction between human beings and animals, plants, natural scenic views, or outdoor activities. Studies have shown that exposure to the outdoors (as a means of contact with nature) reduces perceived stress and promotes health and wellbeing among varying populations in many settings. To date, however, there are few studies exploring the impact of nature contact among college students, especially in the United States. In addition, the determinants of nature contact behavior have not adequately been explored using behavioral theories. The purpose of this study was to use the multi-theory model (MTM) of health behavior change, a contemporary fourth-generation behavioral theory in explaining intentional outdoor nature contact behavior among college students.

  30. Silver, A.M., Goodman, L.A., Chadha, R., Higdon, J., Burton, M., Palabindala, V., Jonnalagadda, N., Thomas, A., O’Donnell, C. Optimizing discharge summaries: A multispecialty, multicenter survey of primary care clinicians. Journal of Patient Safety, 28 Dec 2020, Publish Ahead of Print DOI: 10.1097/pts.0000000000000809 PMID: 33395016

    Patient care in the United States has become increasingly more fragmented, and the discharge summary serves as a critical tool for transmitting information on a patient's hospital admission to the primary care clinician. Some guidelines regarding how to write discharge summaries exist, but few are focused on prioritizing content that is most important to optimize a patient's transition of care. We conducted a national survey across various medical primary care specialties, including trainees and advanced practice providers, to understand the priorities of primary care clinicians. We distributed the survey to 2184 clinicians affiliated with 8 large academic institutions. Our response rate was 21%. Hospital course, discharge diagnoses, medication reconciliation, and follow-up sections were ranked as the most important categories with a 95.5% concordance rate among surveyed institutions. The least important sections were contact numbers for inpatient clinicians, ancillary services, weight-bearing status, and wound care. Similar themes were also identified via consensus review of the free-texted comments, adding that discharge summary style was also important. Other identified barriers to high-quality transition of care are both the limited time primary care clinicians can spend reviewing discharge summaries and lack of adequate communication between hospitalists and the outpatient clinician. High-yield content should be presented at the beginning of the discharge summary and conveyed in a brief, succinct manner to ensure maximal utility of the document as a transition of care tool.

  31. Spell, C.A., Pearlman, R.L., Brodell, R.T., Nahar, V.K. Teledermatology before and after COVID-19: The impact of regulation. The Journal of the Mississippi State Medical Association (Special Edition: COVID-19 in Mississippi). Accepted September 9, 2020.

    COVID-19 has rapidly impacted healthcare across the globe. Hospitals, insurance companies, and medical professionals have been forced to adapt to continually changing administrative conditions. Telemedicine services have been initiated to combat both patient and physician exposure to viral transmission. These efforts have been jump-started by state and federal policy changes initiated early in the COVID-19 pandemic. Most importantly, private insurance companies and CMS have loosened geographical restrictions on telehealth providers and agreed to proper compensation for telemedicine services. Loosening HIPAA regulations was also a critical change that permitted the use of technology platforms that were previously banned.  Telehealth has demonstrated its immense value during the pandemic. If it is to play a continuing role in the provision of dermatology services to individuals with limited access to skin care (nursing homes, prisons, hospitals and rural areas), it will be critically important that pre-Covid regulations are not permitted to snap back into place without thoughtful alterations. 

  32. Streifel, A., Wessman, L., Farah, R., Byrd, A.C., Brodell, R.T., Gaddis, K., Smith, C. Rural residency curricula: A potential target for improved access to care? Cutis. Accepted September 11, 2020.

    Currently, there is an irrefutable trend toward urban dermatology practice in the United States. Despite this, there are few “best practices” to entice dermatologists to work in rural areas or to provide remote dermatology services. Exposure to rural or telemedicine experiences during residency training might increase the likelihood of eventual rural practice. This study was designed to better define viewable online information available to dermatology residency applicants regarding rural dermatology and telemedicine experiences in dermatology residency. Online curricula of all ACGME accredited dermatology residency programs in the US were reviewed. We recorded all programs that: 1) offer specialized “rural track” training 2) offer optional elective time 3) incorporate teledermatology, and 4) teledermoscopy in the curriculum. We noted programs providing exposure to teledermatology experiences at Veterans Affairs (VA) health systems. Thirty-five percent of accredited dermatology residency programs advertised optional elective rotations or focused rural experiences. Explicitly defined exposures to teledermatology and teledermoscopy during training were rare, 12% and <1%, respectively. Thirty-six percent of accredited programs offered rotations at VA hospitals with active teledermatology services. There is a paucity of defined curricula related to teledermatology, teledermoscopy, and rural training on dermatology residency program websites.

  33. Tumminello, K., Cochran, C.A., Brodell, R.T. Online Pearls: The appearance or disappearance of the cornoid lamella due to level and direction of sectioning in porokeratosis [published online ahead of print, 2020 May 18]. Journal of the American Academy of Dermatology. 2020;S0190-9622(20)30920-8.

    Biopsy of lesions of porokeratosis requires inclusion of the thin, raised edge of the scaling patch (Cornoid Lamella) The classic findings of porokeratosis will be insured if a line is drawn perpendicular to the cornoid lamella prior to a punch or shave biopsy and the specimen is bisected by the operator at the bedside. When the punch is bisected through the long axis of the cornoid lamella the specimen will be more difficult to diagnose or missed entirely. A three-dimensional video model permits visualization of countless possible cross-sectional patterns that can occur depending on the exact location the punch specimen is bisected. 

  34. Whiteley L, Olsen E, Mena L, Haubrick K, Craker L, Hershkowitz D, Brown LK. A mobile gaming intervention for persons on pre-exposure prophylaxis: Protocol for intervention development and randomized controlled trial. Journal of Medical Internet Research, Research Protocols. 2020 Sep 14;9(9):e18640. doi: 10.2196/18640. PMID: 32924954

    The goal of this project was to develop and test a cutting-edge, engaging, and entertaining app/gaming intervention for improving adherence to PrEP and building HIV prevention knowledge, skills, and behavior. This study was conducted in two phases. In the developmental phase, we conducted qualitative interviews with young MSM (n=20) to guide the development of the gaming intervention. In the randomized controlled trial, we tested the preliminary efficacy of the gaming intervention compared to a comparison condition among young MSM. Subjects were recruited from the University of Mississippi Medical Center HIV/STI testing clinics (n=60). Institutional review board approval was received in February 2015. Research activities began in June 2015 and are still ongoing. This app/gaming intervention aimed to improve PrEP adherence and HIV preventative behaviors in young MSM. Engaging young MSM in learning information, practicing behaviors, and improving motivation for increased adherence to PrEP has the potential to decrease HIV seroconversion. It is important to develop interventions that are enjoyable, engaging, and easily incorporated into clinical settings.