Abstract 3235: Low LDL is Associated with Hematoma Expansion in Chronic Daily Alcohol Users with Intracranial Hemorrhage

Background: Prior studies have reported elevated blood pressure, platelet inhibition, and low LDL cholesterol in chronic daily alcohol users (CDA). Each of these has been shown to be associated with intracerebral hemorrhage (ICH) growth. We hypothesized that CDA patients with ICH and low LDL were at higher risk for ICH growth than CDA users with high LDL. Methods: Retrospective chart review was performed on patients who presented to Tulane University from 7/1/08-12/31/10 with a spontaneous ICH. Patients who underwent hematoma evacuation were excluded. Clinical and demographic variables were abstracted. Hemorrhages volumes were calculated based on ABC/2 method. LDL was dichotomized into low (<100mg/dl) and high (≥100mg/dl) values. Comparisons were made using t-tests, Chi-square and non-parametric equivalents where appropriate. ICH growth in 24 hours and CDA use were evaluated using linear regression. Results: Of the 99 patients with spontaneous ICH, 25.3% were CDA users. No significant differences were observed when comparing baseline demographics of CDA users with LDL<100 and CDA users with LDL>=100 ( Table 1). Patients with low LDL had larger baseline ICH volumes (21.4 vs. 7.5, p=.03) and were more likely to experience ICH growth (87.5% vs. 57.1%, p=0.0002). Initial LDL was an independent predictor for 24 hour ICH growth. Every 10 points the initial LDL was below 100 predicted 1 cc of growth. LDL did not predict ICH growth in non-CDA users (p=0.9430). Discussion: Our data suggest that initial LDL level in chronic daily alcohol users can be used to predict ICH growth. The role of LDL in the importance of vessel fragility and clot stabilization needs to be further explored as this appears be important in patients who are chronic daily alcohol users.

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Assessing the Risk of Nephrotoxicity Associated With Non-renally Adjusted Intravenous Polymyxin B Compared with Traditional Dosing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.691 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S299-S300

Author(s):

Bejoy Maniara ◽

Thien-Ly Doan ◽

Lauren Healy

Keyword(s):

Ascorbic Acid ◽

Chart Review ◽

Potential Role ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Polymyxin B ◽

Respiratory Arrest ◽

Chi Square ◽

Chi Square Test

Abstract Background Prior data states that polymyxin B is renally cleared and thus required renal adjustments, however newer data suggests that polymyxin B undergoes non-renal clearance. With more aggressive dosing, potential for increased nephrotoxicity is of concern. This study aims to determine whether time to acute kidney injury (AKI) differs between renally adjusted and non-adjusted doses of intravenous (IV) polymyxin B. Secondary objectives aim to evaluate incidence of AKI, length of stay (LOS), adverse reactions, and potential role of ascorbic acid in decreasing nephrotoxicity. Methods This retrospective chart review compared time to AKI in patients receiving renally adjusted and non-adjusted IV polymyxin B between Jan 2012 and Nov 2016. This study included patients who are at least 18 years old, received IV polymyxin B, and have creatinine clearance below 80 mL/minute. Patients were excluded if they had AKI (RIFLE criteria), received renal replacement therapy, or are pregnant prior to receipt of IV polymyxin B. Fine and Gray’s model for competing risks was used to predict the cumulative incidence function of AKI. Descriptive statistics, two-sample t-test, and Chi-square test were used as appropriate. Results Of the 132 patients screened, 54 met inclusion criteria (23 in the renally adjusted vs. 31 in the non-adjusted group). There was no statistical association between dosing type and time to AKI (P = 0.13). Incidence of nephrotoxicity was higher in the renally adjusted vs. non-adjusted groups (21.7% vs. 6.5% respectively). Mortality was higher in the renally adjusted vs. non-adjusted groups (17.4% vs. 6.5% respectively). LOS was greater in the renally adjusted vs. non-adjusted groups (16 vs. 14 days respectively, P = 0.26). All patients in the study received concomitant nephrotoxic agents (e.g., vancomycin, aminoglycosides). Ascorbic acid use was infrequent but, in the 4 patients who did receive it, none developed AKI. No difference in neurotoxicity, respiratory arrest, Clostridium difficile infections was seen. Conclusion No significant association between IV polymyxin B dosing type and time to AKI was found. Incidence of AKI, LOS, and mortality was higher in the renally adjusted group compared with the non-adjusted group. Ascorbic acid may mitigate the nephrotoxic potential of IV polymyxin B, but further studies are needed. Disclosures All authors: No reported disclosures.

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Cardiovascular Health in Individuals with Exceptional Longevity Residing in Arkansas

Gerontology and Geriatric Medicine ◽

10.1177/23337214211018933 ◽

2021 ◽

Vol 7 ◽

pp. 233372142110189

Author(s):

Brandi M. Mize ◽

Brandon Duke ◽

Amanda K. Pangle ◽

Jeanne Y. Wei ◽

Gohar Azhar

Keyword(s):

Heart Failure ◽

Chart Review ◽

Cardiovascular Health ◽

Ldl Cholesterol ◽

Retrospective Chart Review ◽

Hdl Cholesterol ◽

Study Cohort ◽

Old Patients ◽

Genetic Components ◽

Blood Pressures

Cardiovascular disease is a common comorbidity associated with an aging population. However, there is a unique group of individuals whose age-defying qualities are still being investigated. This retrospective chart review analyzed various cardiac and metabolic health parameters to characterize the prevalence of heart failure and metabolic derangements in individuals aged 90 years old or older in central Arkansas. Only 236 of the 291 patients in our study cohort had blood pressures recorded. Of these, 50% had systolic blood pressures ≥140 mmHg. Additionally, 77% had pulse pressures ≥50 mmHg. Of the 96 patients with BNP data, 44% had values ≥300 pg/mL. There was a slight positive correlation between aging and HDL cholesterol, while there was a negative correlation between aging and both total cholesterol and LDL cholesterol. A majority of our patients had both elevated systolic blood pressures and elevated pulse pressures. A majority also had high BNP values, indicative of some degree of heart failure. Additionally, atrial fibrillation was a common arrhythmia identified on EKG. However, these oldest of the old patients had fewer documented metabolic derangements. These findings lay important groundwork for further investigation into lifestyle and genetic components that allow them to live exceptionally long with such comorbidities.

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Risk and Protective Factors Affecting Children in Foster Care: A Pilot Study of the Role of Siblings*

The Canadian Journal of Psychiatry ◽

10.1177/070674379203700904 ◽

1992 ◽

Vol 37 (9) ◽

pp. 616-622 ◽

Cited By ~ 41

Author(s):

M.B. Thorpe ◽

G.T. Swart

Keyword(s):

Foster Care ◽

Protective Factors ◽

School Performance ◽

Extracurricular Activities ◽

Chart Review ◽

Retrospective Chart Review ◽

Factors Affecting ◽

Children In Foster Care ◽

High Risk Children

A retrospective chart review of 115 siblings (from 48 families) simultaneously taken into the care of a Children's Aid Society was conducted. These children were a very neglected group at great risk of developing mental illness. There was a significant correlation between the number of symptoms the child had while in the receiving home and the time spent in foster care. Protective factors correlated with fewer symptoms at home but not while the child was in care. Being in care resulted in better performance at school, fewer symptoms and involvement in more extracurricular activities. High risk children made up their losses. While in foster care, 53% were eventually separated from their siblings. Children were more likely to be separated from their siblings if they were older, their father was physically ill or their parents were separated. Children who were separated from their siblings had more risk factors and placements while in care. However, they had fewer symptoms and better school performance while they were in foster care and fewer symptoms at discharge than the siblings who stayed together.

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4225 Evaluation of Neurotransmitters in Channelopathy-Related Epilepsy

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.298 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 95-95

Author(s):

Sunita N Misra ◽

Theresa M. Czech ◽

Jennifer A. Kearney

Keyword(s):

Mouse Model ◽

Chart Review ◽

Retrospective Chart Review ◽

Brain Regions ◽

Autism Spectrum ◽

Wild Type ◽

Voltage Gated Sodium Channels ◽

Study Population ◽

Genotype A

OBJECTIVES/GOALS: Variants in voltage-gated sodium channels (VGSC) are a common cause of severe early onset epilepsy. Changes in CSF neurotransmitters (NT) were identified in 2 cases of VGSC-related epilepsy. Here we investigate NT changes in patients and a novel mouse model of VGSC-related epilepsy. METHODS/STUDY POPULATION: We conducted a single site IRB approved retrospective chart review of patients with VGSC-related epilepsy who underwent CSF NT testing for diagnostic purposes. In parallel, we examined NT levels from the brains of wild-type (WT) and a novel VGSC-related epilepsy mouse model after obtaining IACUC approval. We rapidly isolated forebrain, cortex, striatum, and brainstem from 5-6 animals per sex and genotype. A combination of HPLC with electrochemical detection and mass spectrometry were used to quantify NT levels from brain samples. RESULTS/ANTICIPATED RESULTS: We identified 10 patients with VGSC-related epilepsy who received CSF NT testing. Two of these patients had abnormal NT results including changes to dopamine (DA) or serotonin (5-HT) metabolites. We analyzed NT levels from four brain regions from male and female WT and VGSC-related epilepsy mice. We anticipate that most of the NT levels will be similar to WT, however subtle changes in the DA or 5-HT metabolites may be seen in VGSC-related epilepsy. DISCUSSION/SIGNIFICANCE OF IMPACT: Patients with VGSC-related epilepsy often have autism spectrum disorder, sleep, and movement disorders. Understanding the role of aberrant NT levels in VGSC-related epilepsy may provide additional therapeutic targets that address common neuropsychological comorbidities as well as seizures.

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Combined Phacoemulsification and Pars Plana Vitrectomy for the Treatment of Cataract in Patients With Noninfectious Uveitis

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420930489 ◽

2020 ◽

Vol 4 (5) ◽

pp. 393-400

Author(s):

Christopher D. Conrady ◽

Akbar Shakoor ◽

Rachel Patel ◽

Marissa Larochelle ◽

Majid Moshirfar ◽

...

Keyword(s):

Surgical Approach ◽

Inflammatory Disease ◽

Chart Review ◽

Retrospective Chart Review ◽

Visual Rehabilitation ◽

Disease Remission ◽

Pars Plana ◽

Vitrectomy Surgery

Purpose: This work evaluates the role of combined phacoemulsification and vitrectomy surgery in the management of cataract associated with noninfectious uveitis. Methods: A retrospective chart review was conducted of all patients aged 7 years or older who underwent a combined surgical approach from 2005 to 2018. Results: Eighty-five eyes of 67 patients were included in the study; 10.7% of eyes had a best-corrected visual acuity (BCVA) of 20/40 or better at time of surgery. At 1-year follow-up, 63.4% of eyes had a BCVA 20/40 or better and 7.6% had a BCVA of 20/200 or worse. There was an overall decrease in cystoid macular edema after surgery compared with preoperatively (47.6% vs 34.5% presurgery and postsurgery, respectively). Complete inflammatory disease remission off immunomodulatory therapy and systemic steroids was achieved in 21.1% of patients. Conclusions: A combined surgical approach is effective in visual rehabilitation in patients with uveitic cataracts and may promote inflammatory disease remission specifically in intermediate uveitis.

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Assessment of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycobacterium tuberculosis infections in women undergoing laparoscopy: the role of peritoneal fluid sampling

Microbiologia Medica ◽

10.4081/mm.2016.6038 ◽

2016 ◽

Vol 31 (4) ◽

Cited By ~ 1

Author(s):

Miroslav Dragic ◽

Patrizia Posteraro ◽

Carla Marani ◽

Maria Emanuela Natale ◽

Alessia Vecchioni ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Chlamydia Trachomatis ◽

Peritoneal Fluid ◽

Bacterial Infections ◽

Chart Review ◽

Molecular Detection ◽

Retrospective Chart Review ◽

Potential Link ◽

Fluid Sampling

Background. Aim of this study was to assess the role of peritoneal fluid sampling for detection of bacterial infections due to Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycobacterium tuberculosis (MT) in women undergoing laparoscopic investigation. The potential link between microbiological positive result(s) and types of gynecological pathology was also evaluated. Materials and Methods. A large sample of women (n=1377) with their peritoneal fluids taken laparoscopically was studied. Data of microbiological and clinical/histopathological findings were entered into a database from a retrospective chart review. Culture and/or microscopy were used to detect NG or MT infection, whereas CT infection was detected using a PCR-based test. Results and Conclusions. Of all the patients (14 to 50 years aged), 463 (33.6%) had endometriosis, 1179 (85.6%) had a pathology/condition other than endometriosis, and 71 (5.2%) had no pathology as histologically documented. None of the patients had peritoneal fluid samples positive for NG or MT. In contrast, 30 (2.2%) of 1377 patients had peritoneal fluid samples positive for CT. Except for 3 women with no histopathological alteration, all the CT positive patients had either endometriosis (n=12) or non-endometriosis (n=13) pathology. Two remaining patients were diagnosed with both the pathologies. Accordingly, no significant association (OR) was found between CT positivity and pathology [only endometriosis, 1.13 (95%CI, 0.30-4.20)]; [only non-endometriosis, 0.53 (95%CI, 0.15-1.87)]. While confirming the low positivity rate for the CT molecular detection, the present data indicate the need for prospective studies to firmly establish the clinical usefulness of peritoneal fluid diagnostic in gynecological settings.

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A Comparison of Sexual Arousal in Men Exposed to Visual Stimuli With and Without Facial Blurring

Sexual Abuse ◽

10.1177/1079063219828784 ◽

2019 ◽

Vol 32 (6) ◽

pp. 619-633 ◽

Cited By ~ 1

Author(s):

Leah Rosetti ◽

Susan Curry ◽

Lisa Murphy ◽

John B. Bradford ◽

J. Paul Fedoroff

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Effect Sizes ◽

Modest Effect Size ◽

Legal Challenges ◽

And Gender ◽

Gender Categories ◽

Facial Images ◽

Modest Effect

The role of the facial images in arousal and attraction has been examined before but never via penile plethysmography (PPG). This retrospective chart review aimed to determine the significance and magnitude of differences in arousal measured by PPG in 1,000 men exposed to slide stimuli with or without facial blurring in subjects of various ages. Arousal in response to blurred stimuli was significantly higher than nonanonymized stimuli with modest effect sizes for slides across age and gender categories. Facial blurring increased differences in arousal between adults and adolescents with a modest effect size. Our findings support the use of facial blurring to further protect the anonymity of models and limit the ethical and legal challenges of using slide stimuli with child models.

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Immediate Intravenous Epinephrine Versus Early Intravenous Epinephrine for In-Hospital Cardiopulmonary Arrest

10.21203/rs.3.rs-153455/v1 ◽

2021 ◽

Author(s):

Abdullah Bakhsh ◽

Maha Safhi ◽

Ashwaq Alghamdi ◽

Amjad Alharazi ◽

Bedoor Alshabibi ◽

...

Keyword(s):

Chart Review ◽

Cardiopulmonary Arrest ◽

Retrospective Chart Review ◽

Spontaneous Circulation ◽

Chi Square ◽

Epinephrine Administration ◽

Return Of Spontaneous Circulation ◽

Study Population ◽

Epinephrine Dose ◽

The Ideal

Abstract Background intravenous epinephrine has been a key treatment for cardiopulmonary arrest since the early 1960s. Although, many studies have questioned neurological outcome benefit, it remains to be recommended in international guidelines for its benefit on return of spontaneous circulation (ROSC). The ideal timing for the first epinephrine dose is uncertain. We aimed to look at the association of immediate epinephrine administration (within 1-minute of cardiac arrest recognition) with return of spontaneous circulation (ROSC) up to 24-hours and beyond 24-hours. Methods this was a multicenter retrospective chart review of patients undergoing cardiopulmonary resuscitation. Descriptive statistics were used to characterize study population, while t-test and chi-square were used to compare groups and outcomes. Results immediate epinephrine administration (within 1-minute) is associated with higher rates of ROSC up to 24-hours (OR = 2.36, 95% CI; [1.46–3.81]) and beyond 24-hours (OR = 2.26, 95% CI; [1.06–4.83]). Conclusions we encourage immediate administration of epinephrine in conjunction with high-quality CPR, as this is associated with higher rates of ROSC.

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Abstract WP226: Isolated Aphasia in the Emergency Department: Prevalence and Characteristics of Isolated Aphasia Due to Stroke Within a Population

Stroke ◽

10.1161/str.48.suppl_1.wp226 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Elisheva R Coleman ◽

Jane C Khoury ◽

Charles J Moomaw ◽

Kathleen Alwell ◽

Brett M Kissela ◽

...

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Left Middle Cerebral Artery ◽

Chi Square ◽

Exact Test ◽

The Public ◽

Language Deficit ◽

Wilcoxon Rank Sum Test ◽

The Mean ◽

Left Middle

Background: Aphasia is a disabling consequence of ischemic stroke (IS), usually caused by strokes in the territory of the left middle cerebral artery. It is often seen as part of a larger syndrome with right hemiparesis and other left hemisphere signs. Isolated aphasia may be difficult to recognize given the lack of motor symptoms, potentially delaying treatment. Our study seeks to determine the prevalence of isolated aphasia, the rate at which these patients call 911, and the rate and speed of treatment with rt-PA compared with the general IS population. Methods: Adult IS patients in 2005 and 2010 in the Greater Cincinnati/Northern KY region (pop. 1.3 million) were ascertained from all local hospitals via ICD-9 codes 430-436, using retrospective chart review. We limited analysis to acute IS cases that presented to an ED. Isolated aphasia was defined by a score >0 on item 9 of the initial rNIHSS (indicating language deficit) and scores of 0 on all other items except 1b and 1c. We compared rates of EMS use and rt-PA administration and median times to presentation and treatment for those with isolated aphasia versus not, using chi-square, Fisher’s exact test, t-test, or Wilcoxon rank-sum test. Results: In 2005 and 2010, 3814 IS cases presented to EDs in the region; 22% were black, 56% were female, and the mean (SD) age was 70 (15) years. Of these, 120 (3.2%) presented with isolated aphasia. Characteristics of the isolated aphasia group are compared with all other IS in Table 1. Isolated aphasia patients showed a trend toward later arrival and lower rate of treatment with rt-PA. Discussion: The trend toward later arrival in patients with isolated aphasia, though not statistically significant, suggests a need to better educate the public on recognizing this stroke syndrome. Isolated aphasia was significantly associated with atrial fibrillation and was associated with decreased small vessel and increased cardioembolic and undetermined stroke subtypes, a finding that merits further study.

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Immune checkpoint inhibitors for treatment of periorbital squamous cell carcinoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-319417 ◽

2021 ◽

pp. bjophthalmol-2021-319417

Author(s):

Jeremy Allan Goldfarb ◽

Renata Ferrarotto ◽

Neil Gross ◽

Ryan Goepfert ◽

James Matthew Debnam ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Chart Review ◽

Checkpoint Inhibitors ◽

Locally Advanced ◽

Retrospective Chart Review ◽

Cutaneous Squamous Cell Carcinoma ◽

Therapeutic Outcomes

PurposeTo report on the outcomes of immunotherapy in patients with locally advanced periorbital squamous cell carcinoma.MethodsWe performed a retrospective chart review of seven consecutive patients with locally advanced periorbital cutaneous squamous cell carcinoma treated with anti-PD-1 immunotherapy. Treatments and therapeutic outcomes were reviewed.ResultsOf the seven patients, six were treated with cemiplimab, and one was treated with pembrolizumab. Five patients were treated with immunotherapy as neoadjuvant therapy before planned surgical resection; two patients received immunotherapy for treatment of advanced recurrent lesions deemed unresectable following multiple previous excisions and radiation therapy. In all seven patients, measurable clinical and/or radiologic response was observed.ConclusionsOur findings support the emerging role of anti-PD-1 immunotherapy in the management of locally advanced periorbital cutaneous squamous cell carcinoma.

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