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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.

    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.

    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.