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Swenson K, Wasserman M, Wujek C, Anspach K, Langsjoen J, Tuuri R. 381 Intra-Nasal Fentanyl for Fracture Patients in the Pediatric Emergency Department. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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2
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Perkins DJ, Yingling AV, Cheng Q, Castillo A, Martinez J, Bradfute SB, Leng S, Edwards J, Guo Y, Mertz G, Harkins M, Unruh M, Worsham A, Lambert CG, Teixeira JP, Seidenberg P, Langsjoen J, Schneider K, Hurwitz I. Elevated SARS-CoV-2 in peripheral blood and increased COVID-19 severity in American Indians/Alaska Natives. Exp Biol Med (Maywood) 2022; 247:1253-1263. [PMID: 35491994 PMCID: PMC9379605 DOI: 10.1177/15353702221091180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/13/2022] [Indexed: 01/08/2023] Open
Abstract
Epidemiological data across the United States show health disparities in COVID-19 infection, hospitalization, and mortality by race/ethnicity. While the association between elevated SARS-CoV-2 viral loads (VLs) (i.e. upper respiratory tract (URT) and peripheral blood (PB)) and increased COVID-19 severity has been reported, data remain largely unavailable for some disproportionately impacted racial/ethnic groups, particularly for American Indian or Alaska Native (AI/AN) populations. As such, we determined the relationship between SARS-CoV-2 VL dynamics and disease severity in a diverse cohort of hospitalized patients. Results presented here are for study participants (n = 94, ages 21-88 years) enrolled in a prospective observational study between May and October 2020 who had SARS-CoV-2 viral clades 20A, C, and G. Based on self-reported race/ethnicity and sample size distribution, the cohort was stratified into two groups: (AI/AN, n = 43) and all other races/ethnicities combined (non-AI/AN, n = 51). SARS-CoV-2 VLs were quantified in the URT and PB on days 0-3, 6, 9, and 14. The strongest predictor of severe COVID-19 in the study population was the mean VL in PB (OR = 3.34; P = 2.00 × 10-4). The AI/AN group had the following: (1) comparable co-morbidities and admission laboratory values, yet more severe COVID-19 (OR = 4.81; P = 0.014); (2) a 2.1 longer duration of hospital stay (P = 0.023); and (3) higher initial and cumulative PB VLs during severe disease (P = 0.025). Moreover, self-reported race/ethnicity as AI/AN was the strongest predictor of elevated PB VLs (β = 1.08; P = 6.00 × 10-4) and detection of SARS-CoV-2 in PB (hazard ratio = 3.58; P = 0.004). The findings presented here suggest a strong relationship between PB VL (magnitude and frequency) and severe COVID-19, particularly for the AI/AN group.
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Affiliation(s)
- Douglas J Perkins
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Alexandra V Yingling
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Qiuying Cheng
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Amber Castillo
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Janae Martinez
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Steven B Bradfute
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Shuguang Leng
- Division of Epidemiology, Biostatistics and Preventative Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Jeremy Edwards
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Yan Guo
- Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Gregory Mertz
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Michelle Harkins
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Anthony Worsham
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Christophe G Lambert
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - J Pedro Teixeira
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Phillip Seidenberg
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Jens Langsjoen
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Kristan Schneider
- Department of Applied Computer- and Bio-Sciences, University of Applied Sciences, Mittweida 09648, Germany
| | - Ivy Hurwitz
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
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Jarratt L, Situ J, King RD, Montanez Ramos E, Groves H, Ormesher R, Cossé M, Raboff A, Mahajan A, Thompson J, Ko RF, Paltrow-Krulwich S, Price A, Hurwitz AML, CampBell T, Epler LT, Nguyen F, Wolinsky E, Edwards-Fligner M, Lobo J, Rivera D, Langsjoen J, Sloane L, Hendrix I, Munde EO, Onyango CO, Olewe PK, Anyona SB, Yingling AV, Lauve NR, Kumar P, Stoicu S, Nestsiarovich A, Bologa CG, Oprea TI, Tollestrup K, Myers OB, Anixter M, Perkins DJ, Lambert CG. A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study. JMIR Med Educ 2022; 8:e23845. [PMID: 35142625 PMCID: PMC8908195 DOI: 10.2196/23845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/29/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND On March 11, 2020, the New Mexico Governor declared a public health emergency in response to the COVID-19 pandemic. The New Mexico medical advisory team contacted University of New Mexico (UNM) faculty to form a team to consolidate growing information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease to facilitate New Mexico's pandemic management. Thus, faculty, physicians, staff, graduate students, and medical students created the "UNM Global Health COVID-19 Intelligence Briefing." OBJECTIVE In this paper, we sought to (1) share how to create an informative briefing to guide public policy and medical practice and manage information overload with rapidly evolving scientific evidence; (2) determine the qualitative usefulness of the briefing to its readers; and (3) determine the qualitative effect this project has had on virtual medical education. METHODS Microsoft Teams was used for manual and automated capture of COVID-19 articles and composition of briefings. Multilevel triaging saved impactful articles to be reviewed, and priority was placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and information on health care and policy response to COVID-19. The finalized briefing was disseminated by email, a listserv, and posted on the UNM digital repository. A survey was sent to readers to determine briefing usefulness and whether it led to policy or medical practice changes. Medical students, unable to partake in direct patient care, proposed to the School of Medicine that involvement in the briefing should count as course credit, which was approved. The maintenance of medical student involvement in the briefings as well as this publication was led by medical students. RESULTS An average of 456 articles were assessed daily. The briefings reached approximately 1000 people by email and listserv directly, with an unknown amount of forwarding. Digital repository tracking showed 5047 downloads across 116 countries as of July 5, 2020. The survey found 108 (95%) of 114 participants gained relevant knowledge, 90 (79%) believed it decreased misinformation, 27 (24%) used the briefing as their primary source of information, and 90 (79%) forwarded it to colleagues. Specific and impactful public policy decisions were informed based on the briefing. Medical students reported that the project allowed them to improve on their scientific literature assessment, stay current on the pandemic, and serve their community. CONCLUSIONS The COVID-19 briefings succeeded in informing and guiding New Mexico policy and clinical practice. The project received positive feedback from the community and was shown to decrease information burden and misinformation. The virtual platforms allowed for the continuation of medical education. Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing led by faculty.
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Affiliation(s)
- LynnMarie Jarratt
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Jenny Situ
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Rachel D King
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Hannah Groves
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Ryen Ormesher
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Melissa Cossé
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Alyse Raboff
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Avanika Mahajan
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Jennifer Thompson
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Randy F Ko
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Allison Price
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Timothy CampBell
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Lauren T Epler
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Fiona Nguyen
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Emma Wolinsky
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Jolene Lobo
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Danielle Rivera
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Jens Langsjoen
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Lori Sloane
- University of New Mexico Health Sciences Library and Informatics Center, Albuquerque, NM, United States
| | - Ingrid Hendrix
- University of New Mexico Health Sciences Library and Informatics Center, Albuquerque, NM, United States
| | - Elly O Munde
- University of New Mexico-Maseno Global Health Programs Laboratories, Kisumu, Kenya
- Department of Clinical Medicine, School of Health Sciences, Kirinyaga University, Kerugoya, Kenya
| | - Clinton O Onyango
- University of New Mexico-Maseno Global Health Programs Laboratories, Kisumu, Kenya
| | - Perez K Olewe
- University of New Mexico-Maseno Global Health Programs Laboratories, Kisumu, Kenya
| | - Samuel B Anyona
- University of New Mexico-Maseno Global Health Programs Laboratories, Kisumu, Kenya
- Department of Medical Biochemistry, School of Medicine, Maseno University, Maseno, Kenya
| | - Alexandra V Yingling
- Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Nicolas R Lauve
- Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
- Department of Computer Science, University of New Mexico, Albuquerque, NM, United States
| | - Praveen Kumar
- Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
- Department of Computer Science, University of New Mexico, Albuquerque, NM, United States
| | - Shawn Stoicu
- Health and Sciences Center Sponsored Projects Office, University of New Mexico, Albuquerque, NM, United States
| | - Anastasiya Nestsiarovich
- Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Cristian G Bologa
- University of New Mexico School of Medicine, Albuquerque, NM, United States
- Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Tudor I Oprea
- University of New Mexico School of Medicine, Albuquerque, NM, United States
- Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Kristine Tollestrup
- University of New Mexico College of Population Health, Albuquerque, NM, United States
| | - Orrin B Myers
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Mari Anixter
- New Mexico Department of Health, Communications Office, Office of the Secretary, Santa Fe, NM, United States
| | - Douglas J Perkins
- University of New Mexico School of Medicine, Albuquerque, NM, United States
- Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Christophe Gerard Lambert
- Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Bartlett C, Langsjoen J, Cheng Q, Yingling AV, Weiss M, Bradfute S, Perkins DJ, Hurwitz I. COVID-19 global pandemic planning: Presence of SARS-CoV-2 fomites in a university hospital setting. Exp Biol Med (Maywood) 2021; 246:2039-2045. [PMID: 34219476 PMCID: PMC8461048 DOI: 10.1177/15353702211024597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has surged across the globe, great effort has been expended to understand mechanisms of transmission and spread. From a hospital perspective, this topic is critical to limit and prevent SARS-CoV-2 iatrogenic transmission within the healthcare environment. Currently, the virus is believed to be transmitted primarily through respiratory droplets, but a growing body of evidence suggests that spread is also possible through aerosolized particles and fomites. Amidst a growing volume of patients with coronavirus disease 2019 (COVID-19), the purpose of this study was to evaluate the potential for SARS-CoV-2 transmission through fomites. Samples collected from the exposed skin of clinicians (n = 42) and high-touch surfaces (n = 40) were collected before and after encounters with COVID-19 patients. Samples were analyzed using two assays: the CDC 2019-nCoV Real-Time Reverse Transcription polymerase chain reaction (RT-qPCR) assay, and a SYBR Green assay that targeted a 121 bp region within the S-gene of SARS-CoV-2. None of the samples tested positive with the CDC assay, while two high-touch surface areas tested positive for SARS-CoV-2 using the Spike assay. However, viral culture did not reveal viable SARS-CoV-2 from the positive samples. Overall, the results from this study suggest that SARS-CoV-2 RNA were not widely present either on exposed skin flora or high-touch surface areas in the hospital locations tested. The inability to recover viable virus from samples that tested positive by the molecular assays, however, does not rule out the possibility of SARS-CoV-2 transmission through fomites.
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Affiliation(s)
- Christopher Bartlett
- Department of Internal Medicine, University of New Mexico Health
Sciences Center, Albuquerque, NM 87131, USA
| | - Jens Langsjoen
- Department of Internal Medicine, University of New Mexico Health
Sciences Center, Albuquerque, NM 87131, USA
| | - Qiuying Cheng
- Department of Internal Medicine, University of New Mexico Health
Sciences Center, Albuquerque, NM 87131, USA
| | - Alexandra V Yingling
- Department of Internal Medicine, University of New Mexico Health
Sciences Center, Albuquerque, NM 87131, USA
| | - Myissa Weiss
- School of Medicine, University of New Mexico Health Sciences
Center, Albuquerque, NM 87131, USA
| | - Steven Bradfute
- Department of Internal Medicine, University of New Mexico Health
Sciences Center, Albuquerque, NM 87131, USA
| | - Douglas J Perkins
- Department of Internal Medicine, University of New Mexico Health
Sciences Center, Albuquerque, NM 87131, USA
| | - Ivy Hurwitz
- Department of Internal Medicine, University of New Mexico Health
Sciences Center, Albuquerque, NM 87131, USA
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5
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Luo A, Muraida S, Pinchotti D, Richardson E, Ye E, Hollingsworth B, Win A, Myers O, Langsjoen J, Valles E, Zolyomi A, Quinn DK. Bispectral Index Monitoring With Density Spectral Array for Delirium Detection. J Acad Consult Liaison Psychiatry 2020; 62:318-329. [PMID: 33223218 DOI: 10.1016/j.psym.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Delirium in hospitalized patients often goes undetected. Cerebral state monitors, which measure limited-channel electroencephalography, have shown potential for improving delirium detection. OBJECTIVE The aim of this study was to compare an FDA-approved cerebral state monitor, bispectral index monitoring with density spectral array (DSA), for delirium identification with clinical screening methods. METHODS Hospitalized patients receiving psychiatric consultation were assessed for delirium using the 3-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and underwent bispectral index monitor + DSA monitoring. Visual inspection of frequency band power of the DSA was performed by 2 trained independent raters. Average hue values were calculated for each frequency band using image analysis software as the device did not allow for extraction of raw electroencephalography data. Delirious versus nondelirious group averages, sensitivity, specificity, and area under the curve were calculated for significant DSA variables and the 3D-CAM. RESULTS In an initial cohort of 43 patients, visual ratings of the DSA were not associated with delirium (P > 0.1). In a larger cohort of 123 subjects, multiple band hue ratios were associated with delirium, although none survived correction for multiple comparisons. In a subgroup of 74 non-neurological patients, low theta/low delta ratio was significantly associated with delirium (P = 0.001) (sensitivity/specificity/area under the curve: 83%/70%/0.757; 3D-CAM: 67%/77%/0.717; paired-sample area under the curve difference: -0.040, P = 0.68). In 21 patients with dementia, low theta power demonstrated significantly greater sensitivity/specificity/area under the curve of 83%/78%/0.824, whereas 3D-CAM achieved 50%/78%/0.639 (P = 0.04). CONCLUSION Bispectral index monitor + DSA was similar to 3D-CAM for detecting delirium in hospitalized patients with and without neurological disorders, and was significantly more accurate in patients with dementia. More studies are needed to validate the use of cerebral state monitors for quantitative delirium detection.
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Affiliation(s)
- Alice Luo
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131.
| | - Susan Muraida
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, 87131
| | - Dana Pinchotti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| | - Elizabeth Richardson
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| | - Enstin Ye
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| | | | - Alexander Win
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, 87131
| | - Jens Langsjoen
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, 87106
| | - Emiliano Valles
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| | - Arpad Zolyomi
- Department of Anesthesiology, University of New Mexico, Albuquerque, NM, 87106
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
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Perkins DJ, Villescas S, Wu TH, Muller T, Bradfute S, Hurwitz I, Cheng Q, Wilcox H, Weiss M, Bartlett C, Langsjoen J, Seidenberg P. COVID-19 global pandemic planning: Decontamination and reuse processes for N95 respirators. Exp Biol Med (Maywood) 2020; 245:933-939. [PMID: 32397762 PMCID: PMC7235442 DOI: 10.1177/1535370220925768] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/18/2022] Open
Abstract
IMPACT STATEMENT There is a critical shortage of personal protective equipment (PPE) around the globe. This article describes the safe collection, storage, and decontamination of N95 respirators using hydrogen peroxide vapor (HPV). This article is unique because it describes the HPV process in an operating room, and is therefore, a deployable method for many healthcare settings. Results presented here offer creative solutions to the current PPE shortage.
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Affiliation(s)
- Douglas J Perkins
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
- University of New Mexico-Kenya Programs, Kisumu and Siaya, 40100, Kenya
| | - Steven Villescas
- Facilities Safety, University of New Mexico Hospital, Albuquerque, NM 87131, USA
| | - Terry H Wu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Center for Infectious Disease and Immunity, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Timothy Muller
- Office of Research, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Steven Bradfute
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Ivy Hurwitz
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Qiuying Cheng
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Hannah Wilcox
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Myissa Weiss
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Chris Bartlett
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Jens Langsjoen
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Phil Seidenberg
- University of New Mexico-Kenya Programs, Kisumu and Siaya, 40100, Kenya
- Department of Emergency Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
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Perkins DJ, Villescas S, Wu TH, Muller T, Bradfute S, Hurwitz I, Cheng Q, Wilcox H, Weiss M, Bartlett C, Langsjoen J, Seidenberg P. COVID-19 global pandemic planning: Decontamination and reuse processes for N95 respirators. Exp Biol Med (Maywood) 2020; 245:933-939. [PMID: 32397762 DOI: 10.1101/2020.04.09.20060129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
There is a critical shortage of personal protective equipment (PPE) around the globe. This article describes the safe collection, storage, and decontamination of N95 respirators using hydrogen peroxide vapor (HPV). This article is unique because it describes the HPV process in an operating room, and is therefore, a deployable method for many healthcare settings. Results presented here offer creative solutions to the current PPE shortage.
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Affiliation(s)
- Douglas J Perkins
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
- University of New Mexico-Kenya Programs, Kisumu and Siaya, 40100, Kenya
| | - Steven Villescas
- Facilities Safety, University of New Mexico Hospital, Albuquerque, NM 87131, USA
| | - Terry H Wu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Center for Infectious Disease and Immunity, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Timothy Muller
- Office of Research, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Steven Bradfute
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Ivy Hurwitz
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Qiuying Cheng
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Hannah Wilcox
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Myissa Weiss
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Chris Bartlett
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Jens Langsjoen
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Phil Seidenberg
- University of New Mexico-Kenya Programs, Kisumu and Siaya, 40100, Kenya
- Department of Emergency Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
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Langsjoen J, Neuwelt A, Eberhardt S, Mlady G, Shukla U, Murali S, Pizanis C, Sillerud LO. A comparison of ferumoxytol with gadolinium as contrast agents for the diagnostic magnetic resonance imaging of osteomyelitis. Magn Reson Imaging 2020; 71:45-54. [PMID: 32439428 DOI: 10.1016/j.mri.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ferumoxytol, an FDA-approved superparamagnetic iron oxide nanoparticle (SPION) preparation used for the treatment of iron deficiency anemia, is also known to be taken up by macrophages in areas of infection or inflammation, where it produces negative contrast changes on T2-weighted MR images. PURPOSE We sought to compare Ferumoxytol-induced MRI contrast changes with those observed using standard-of-care Gadolinium in patients presenting with symptoms suggestive of osteomyelitis. SUBJECTS Out of eighteen enrolled patients, 15 had MR imaging with both ferumoxytol and gadolinium. Based on clinical and/or pathologic criteria, 7 patients were diagnosed with osteomyelitis, 5 patients had osteomyelitis ruled out, and in 3 patients a definitive diagnosis could not be made. FIELD STRENGTH 1.5 Tesla. SEQUENCES Used included STIR, T1-weighted and T2-weighted spin echo. ASSESSMENT The mean contrast changes upon ferumoxytol and gadolinium administration were measured from lesion regions of interest and compared with control regions. STATISTICAL TESTS Student's t-test, propagation of errors. Data are reported as means ± S.E. RESULTS The mean contrast changes, ΔC, associated with a diagnosis of osteomyelitis were found to be ΔCFe = -2.7 ± 0.7 when Ferumoxytol and T2w imaging sequences were used and ΔCGd = +3.1 ± 1.1 (P < 0.001) when Gadolinium and a T1w imaging sequence was used. The MRI contrast changes for both agents correlated with systemic markers of inflammation, such as the erythrocyte sedimentation rate. In patients without osteomyelitis, no significant contrast changes were observed in T2-weighted, Ferumoxytol-contrasted MRI. The macrophages in osteomyelitic lesions were found to take up at least 16 times as much iron as benign bone marrow. DATA CONCLUSION We conclude that in terms of its MRI diagnostic accuracy for osteomyelitis Ferumoxytol-contrasted MRI is a promising approach for diagnosing osteomyelitis that merits further study.
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Affiliation(s)
- Jens Langsjoen
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States of America
| | - Alex Neuwelt
- Department of Medical Oncology, Department of Veterans Affairs, Richmond, VA 23249, United States of America
| | - Stephen Eberhardt
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States of America
| | - Gary Mlady
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States of America
| | - Utkarsh Shukla
- University of New Mexico School of Medicine, Albuquerque, NM 87131, United States of America
| | - Sowmiya Murali
- University of New Mexico School of Medicine, Albuquerque, NM 87131, United States of America
| | - Charles Pizanis
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States of America
| | - Laurel O Sillerud
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States of America.
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Lacy M, Roesch J, Langsjoen J. Things We Do for No Reason: Prealbumin Testing to Diagnose Malnutrition in the Hospitalized Patient. J Hosp Med 2019; 14:239-241. [PMID: 30933675 DOI: 10.12788/jhm.3088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/19/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Mary Lacy
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Justin Roesch
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Jens Langsjoen
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Swenson K, Rankin S, Daconti L, Villarreal T, Langsjoen J, Braude D. Safety of bolus-dose phenylephrine for hypotensive emergency department patients. Am J Emerg Med 2018; 36:1802-1806. [DOI: 10.1016/j.ajem.2018.01.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/30/2018] [Indexed: 11/29/2022] Open
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Neuwelt A, Langsjoen J, Byrd T, Eberhardt S, Mlady G, Baca J, Bocklage T, Martinez C, Orner J, Rivera M, Sillerud LO. Ferumoxytol negatively enhances T 2 -weighted MRI of pedal osteomyelitis in vivo. J Magn Reson Imaging 2016; 45:1241-1245. [PMID: 27654009 DOI: 10.1002/jmri.25437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/08/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alex Neuwelt
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jens Langsjoen
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Thomas Byrd
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Stephen Eberhardt
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Gary Mlady
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Justin Baca
- Department of Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Therese Bocklage
- The Human Tissue Repository, Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Cathleen Martinez
- The Human Tissue Repository, Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jonathan Orner
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Marisa Rivera
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Laurel O Sillerud
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Abstract
BACKGROUND Transurethral resection of the prostate (TURP) has been the gold-standard treatment for alleviating urinary symptoms and improving urinary flow in men with symptomatic benign prostatic hyperplasia (BPH). However, the morbidity of TURP approaches 20%, and less invasive techniques have been developed for treating BPH. Preliminary data suggest that microwave thermotherapy, which delivers microwave energy to produce coagulation necrosis in prostatic tissue, is a safe, effective treatment for BPH. OBJECTIVES To assess the therapeutic efficacy and safety of microwave thermotherapy techniques for treating men with symptomatic benign prostatic obstruction. SEARCH METHODS Randomized controlled trials were identified from The Cochrane Library, MEDLINE, EMBASE, bibliographies of retrieved articles, reviews, technical reports, and by contacting relevant expert trialists and microwave manufacturers. SELECTION CRITERIA All randomized controlled trials evaluating transurethral microwave thermotherapy (TUMT) for men with symptomatic BPH were eligible for this review. Comparison groups could include transurethral resection of the prostate, minimally invasive prostatectomy techniques, sham thermotherapy procedures, and medications. Outcome measures included urinary symptoms, urinary function, prostate volume, mortality, morbidity, and retreatment. Two review authors independently identified potentially relevant abstracts and then assessed the full papers for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted study design, baseline characteristics, and outcomes data and assessed methodological quality using a standard form. We attempted to obtain missing data from authors or sponsors, or both. MAIN RESULTS In this update, we identified no new randomized comparisons of TUMT that provided evaluable effectiveness data. Fifteen studies involving 1585 patients met the inclusion criteria, including six comparisons of microwave thermotherapy with TURP, eight comparisons with sham thermotherapy procedures, and one comparison with an alpha-blocker. Study durations ranged from 3 to 60 months. The mean age of participants was 66.8 years and the baseline symptom scores and urinary flow rates, which did not differ across treatment groups, demonstrated moderately severe lower urinary tract symptoms. The pooled mean urinary symptom scores decreased by 65% with TUMT and by 77% with TURP. The weighted mean difference (WMD) with 95% confidence interval (CI) for the International Prostate Symptom Score (IPSS) was -1.00 (95% CI -2.03 to -0.03), favoring TURP. The pooled mean peak urinary flow increased by 70% with TUMT and by 119% with TURP. The WMD for peak urinary flow was 5.08 mL/s (95% CI 3.88 to 6.28 mL/s), favoring TURP. Compared to TURP, TUMT was associated with decreased risks for retrograde ejaculation, treatment for strictures, hematuria, blood transfusions, and the transurethral resection syndrome, but increased risks for dysuria, urinary retention, and retreatment for BPH symptoms. Microwave thermotherapy improved IPSS symptom scores (WMD -5.15, 95% CI -4.26 to -6.04) and peak urinary flow (WMD 2.01 mL/s, 95% CI 0.85 to 3.16) compared with sham procedures. Microwave thermotherapy also improved IPSS symptom scores (WMD -4.20, 95% CI -3.15 to -5.25) and peak urinary flow (WMD 2.30 mL/s, 95% CI 1.47 to 3.13) in the one comparison with alpha-blockers. No studies evaluated the effects of symptom duration, patient characteristics, prostate-specific antigen levels, or prostate volume on treatment response. AUTHORS' CONCLUSIONS Microwave thermotherapy techniques are effective alternatives to TURP and alpha-blockers for treating symptomatic BPH in men with no history of urinary retention or previous prostate procedures and prostate volumes between 30 to 100 mL. However, TURP provided greater symptom score and urinary flow improvements and reduced the need for subsequent BPH treatments compared to TUMT. Small sample sizes and differences in study design limit comparisons between devices with different designs and energy levels. The effects of symptom duration, patient characteristics, or prostate volume on treatment response are unknown.
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Affiliation(s)
- Richard M Hoffman
- General InternalMedicine 111GIM, New Mexico VA Health Care System, Albuquerque, New Mexico, USA.
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