Faculty Scholarship

The Faculty Scholarship webpage is designed to share the news of faculty accomplishments in medical education including publications, conference presentations, and grants. The webpage may also serve as a resource for faculty looking to identify collaborators with shared research interests. Entries are accepted throughout the academic year, and the page is updated monthly.

March 2021 features:

Publications

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.

Presentations

1. Brooks JT. Putting the “R” Back Into SRS: Building a research program without support. SRS Annual Meeting Lunchtime Symposium. February 28, 2021. Changed from Phoenix, AZ to Virtual.
   
   Invited Speaker and Moderator.
   
   
2. Brooks JT, Murphy RF, El-Hawary R, Mcdonald T, Sponseller PD, Vitale MG, Oetgen M, Wright P, Fitzgerald RE, Cahill PJ, Sukkarieh H. Quantity vs quality of distal fixation points in neuromuscular early onset scoliosis: Does it matter? International Congress on Early Onset Scoliosis And Growing Spine. November 14, 2020. (Virtual)
   
   
3. Matson, S. The opioid crisis and treatment of adolescents and young adults with medication for opioid use disorder (MOUD). Children’s Hospital Foundation Paul and Ann Milburn Lecture, University of Oklahoma Department of Pediatrics. March 10, 2021.
   
   
4. McDonald TC, Wright PB, Brooks JT, Sukkarieh H. The value-added benefit of utilizing two attending surgeons for patients with scoliosis secondary to cerebral palsy. 2020 International Meeting on Advanced Spine Techniques. July 6 - December 31, 2020. (Virtual)
   
   
5. Pinto M, Randhawa R, Bhanat E, Brooks JT. The Gladden Society Honor Roll: A ranking of orthopaedic residency programs by percentage of Black residents. AMA Research Symposium. December 3-6, 2020. (Virtual)

Grants

1. Chronic Venous Thrombosis: Relief with Adjunctive Catheter-Directed Therapy (C-TARCT) Ajinkya Desai, MD, NIH funded multicenter RCT
   
   The primary goal of the trial is to evaluate the efficacy of iliac venous stenting in patient who have moderate to severe post-thrombotic syndrome due to chronic iliofemoral DVT.