Faculty Bibliography
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department:Medicine. General Internal Medicine
recentyears:2
school:SOM
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14494
Naturalization of the microbiota developmental trajectory of Cesarean-born neonates after vaginal seeding
BACKGROUND:Early microbiota perturbations are associated with disorders that involve immunological underpinnings. Cesarean section (CS)-born babies show altered microbiota development in relation to babies born vaginally. Here we present the first statistically powered longitudinal study to determine the effect of restoring exposure to maternal vaginal fluids after CS birth. METHODS:Using 16S rRNA gene sequencing, we followed the microbial trajectories of multiple body sites in 177 babies over the first year of life; 98 were born vaginally, and 79 were born by CS, of whom 30 were swabbed with a maternal vaginal gauze right after birth. FINDINGS:Compositional tensor factorization analysis confirmed that microbiota trajectories of exposed CS-born babies aligned more closely with that of vaginally born babies. Interestingly, the majority of amplicon sequence variants from maternal vaginal microbiomes on the day of birth were shared with other maternal sites, in contrast to non-pregnant women from the Human Microbiome Project (HMP) study. CONCLUSIONS:The results of this observational study prompt urgent randomized clinical trials to test whether microbial restoration reduces the increased disease risk associated with CS birth and the underlying mechanisms. It also provides evidence of the pluripotential nature of maternal vaginal fluids to provide pioneer bacterial colonizers for the newborn body sites. This is the first study showing long-term naturalization of the microbiota of CS-born infants by restoring microbial exposure at birth. FUNDING:C&D, Emch Fund, CIFAR, Chilean CONICYT and SOCHIPE, Norwegian Institute of Public Health, Emerald Foundation, NIH, National Institute of Justice, Janssen.
PMCID:9123283
PMID: 35590169
ISSN: 2666-6340
CID: 5232562
Risk stratification for hydronephrosis in the evaluation of acute kidney injury: a cross-sectional analysis
OBJECTIVE:To validate an existing clinical decision support tool to risk-stratify patients with acute kidney injury (AKI) for hydronephrosis and compare the risk stratification framework with nephrology consultant recommendations. SETTING:Cross-sectional study of hospitalised adults with AKI who had a renal ultrasound (RUS) ordered at a large, tertiary, academic medical centre. PARTICIPANTS:Two hundred and eighty-one patients were included in the study cohort. Based on the risk stratification framework, 111 (40%), 76 (27%) and 94 (33%) patients were in the high-risk, medium-risk and low-risk groups for hydronephrosis, respectively. OUTCOMES:Outcomes were the presence of unilateral or bilateral hydronephrosis on RUS. RESULTS:Thirty-five patients (12%) were found to have hydronephrosis. The high-risk group had 86% sensitivity and 67% specificity for identifying hydronephrosis. A nephrology consult was involved in 168 (60%) patients and RUS was recommended by the nephrology service in 95 (57%) cases. Among patients with a nephrology consultation, 9 (56%) of the 16 total patients with hydronephrosis were recommended to obtain an RUS. CONCLUSIONS:We further externally validated a risk stratification framework for hydronephrosis. Clinical decision support systems may be useful to supplement clinical judgement in the evaluation of AKI.
PMID: 34389565
ISSN: 2044-6055
CID: 4969112
Hickam's dictum, Occam's razor, and Crabtree's bludgeon: a case of renal failure and a clavicular mass
OBJECTIVES/OBJECTIVE:Our discussant's thoughtful consideration of the patient's case allows for review of three maxims of medicine: Occam's razor (the simplest diagnosis is the most likely to be correct), Hickam's dictum (multiple disease entities are more likely than one), and Crabtree's bludgeon (the tendency to make data fit to an explanation we hold dear). CASE PRESENTATION/METHODS:A 66-year-old woman with a history of hypertension presented to our hospital one day after arrival to the United States from Guinea with chronic daily vomiting, unintentional weight loss and progressive shoulder pain. Her labs are notable for renal failure, nephrotic range proteinuria and normocytic anemia while her shoulder X-ray shows osseous resorption in the lateral right clavicle. Multiple myeloma became the team's working diagnosis; however, a subsequent shoulder biopsy was consistent with follicular thyroid carcinoma. Imaging suggested the patient's renal failure was more likely a result of a chronic, unrelated process. CONCLUSIONS:It is tempting to bludgeon diagnostic possibilities into Occam's razor. Presumption that a patient's signs and symptoms are connected by one disease process often puts us at a cognitive advantage. However, atypical presentations, multiple disease processes, and unique populations often lend themselves more to Hickam's dictum than to Occam's razor. Diagnostic aids include performing a metacognitive checklist, engaging analytic thinking, and acknowledging the imperfections of these axioms.
PMID: 34355545
ISSN: 2194-802x
CID: 4988732
Barriers to the Use of Clinical Decision Support for the Evaluation of Pulmonary Embolism: Qualitative Interview Study
BACKGROUND:Clinicians often disregard potentially beneficial clinical decision support (CDS). OBJECTIVE:In this study, we sought to explore the psychological and behavioral barriers to the use of a CDS tool. METHODS:We conducted a qualitative study involving emergency medicine physicians and physician assistants. A semistructured interview guide was created based on the Capability, Opportunity, and Motivation-Behavior model. Interviews focused on the barriers to the use of a CDS tool built based on Wells' criteria for pulmonary embolism to assist clinicians in establishing pretest probability of pulmonary embolism before imaging. RESULTS:Interviews were conducted with 12 clinicians. Six barriers were identified, including (1) Bayesian reasoning, (2) fear of missing a pulmonary embolism, (3) time pressure or cognitive load, (4) gestalt includes Wells' criteria, (5) missed risk factors, and (6) social pressure. CONCLUSIONS:Clinicians highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers will be paramount in developing CDS that can meet its potential to transform clinical care.
PMCID:8374661
PMID: 34346901
ISSN: 2292-9495
CID: 4996242
Adaptation of a Dietary Screener for Asian Americans
No brief dietary screeners are available that capture dietary consumption patterns of Asian Americans. The purpose of this article is to describe the cultural adaptation of the validated Dietary Screener Questionnaire (DSQ) for use by clinicians, researchers, and community-based partners seeking to understand and intervene on dietary behaviors among English-speaking Asian Americans, for the six largest Asian subgroups (Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese) in the United States. This was mainly accomplished by adding culturally specific examples of foods to the questionnaire items via searching online databases and soliciting input from members of our community partner network representing each of the six largest Asian subgroups. Over half of the 26 items on the DSQ were modified to include more culturally specific foods. Developing high-quality tools that reflect the diversity of the U.S. population are critical to implement nutrition interventions that do not inadvertently widen health disparities.
PMID: 34344202
ISSN: 1524-8399
CID: 5005942
Disseminated Herpes Simplex Virus-2 (HSV-2) as a Cause of Viral Hepatitis in an Immunocompetent Host [Case Report]
BACKGROUND Herpes simplex virus-2 (HSV-2) affects nearly 1 in 5 adults in the United States. Complications such as viral hepatitis and dissemination are rare in immunocompetent hosts. In this report, we describe a case of viral hepatitis secondary to disseminated HSV-2 in an immunocompetent patient with recurrent fevers and elevated aminotransferases. CASE REPORT A 57-year-old man with a history of type 2 diabetes and hypertension was admitted with a right index finger lesion concerning for an abscess. He underwent successful incision and drainage and was started on ampicillin-sulbactam. On Day 2 of hospitalization, he developed recurrent fevers and elevated aminotransferases and inflammatory markers. An extensive infectious, rheumatologic, and malignancy workup were pursued without immediate findings. Imaging demonstrated cirrhotic morphology of the liver and splenomegaly, but lab markers were intact for liver synthetic function. On Day 7 of hospitalization, fever frequency decreased, and HSV-2 titers resulted, with positive IgM and negative IgG. He subsequently developed erythematous, raised lesions in multiple dermatomes. Nucleic acid amplification testing of biopsied lesions was positive for HSV-2, confirming viral hepatitis secondary to disseminated HSV-2. He was started on intravenous acyclovir and discharged on valacyclovir following improvement in symptoms. CONCLUSIONS We report a case of viral hepatitis secondary to disseminated HSV-2 in an immunocompetent host. Up to 25% of cases occur in immunocompetent hosts and many patients do not develop characteristic skin lesions. Early diagnosis and treatment of viral hepatitis secondary to disseminated HSV remains vital to minimize morbidity and mortality.
PMCID:8349572
PMID: 34341324
ISSN: 1941-5923
CID: 5004192
Coronary Artery Calcium Scoring for Adults at Borderline 10-Year ASCVD Risk: The CAC Consortium [Letter]
PMID: 34325843
ISSN: 1558-3597
CID: 4961802
Intake of artificial sweeteners among adults is associated with reduced odds of gastrointestinal luminal cancers: a meta-analysis of cohort and case-control studies
The association between artificial sweetener (AS) consumption and the risk of organ-specific cancers has been debated for decades. We hypothesized that AS consumption is associated with reduced risk of gastrointestinal (GI) cancers. We aimed to test this hypothesis by conducting a systematic review and meta-analysis of the association between AS and GI cancers. We searched 4 databases for comparative studies of AS consumption (exposed) versus no consumption (nonexposed) and the odds or risk of GI luminal or non-luminal cancer (primary outcome). Estimates were pooled using a random-effects model. Studies were evaluated for quality, bias, and heterogeneity. We analyzed 8 (4 prospective, 4 case-control) studies comprising data on 1,043,496 individuals, among whom 3271 pancreatic, 395 gastric, 304 esophageal, 3008 colorectal, and 598 oropharyngeal cancers occurred. While there was no significant association between AS consumption and odds of GI cancer overall, AS consumption was associated with 19% reduced likelihood of luminal GI cancer (OR 0.81, 95% CI:0.68-0.97). There was no association between AS consumption and non-luminal GI cancer. Meta-regression demonstrated no difference in effect estimates based on study type. Based on this first meta-analysis of AS and GI cancer, we demonstrated that AS consumption is associated with a significantly lower likelihood of luminal, but not non-luminal, GI cancer.
PMID: 34461350
ISSN: 1879-0739
CID: 4989222
Genome-Wide Heritability Estimates for Family Life Course Complexity
Sequence analysis is an established method used to study the complexity of family life courses. Although individual and societal characteristics have been linked with the complexity of family trajectories, social scientists have neglected the potential role of genetic factors in explaining variation in family transitions and events across the life course. We estimate the genetic contribution to sequence complexity and a wide range of family demographic behaviors using genomic relatedness-based, restricted maximum likelihood models with data from the U.S. Health and Retirement Study. This innovative methodological approach allows us to provide the first estimates of the heritability of composite life course outcomes-that is, sequence complexity. We demonstrate that a number of family demographic indicators (e.g., the age at first birth and first marriage) are heritable and provide evidence that composite metrics can be influenced by genetic factors. For example, our results show that 11% of the total variation in the complexity of differentiated family sequences is attributable to genetic influences. Moreover, we test whether this genetic contribution varies by social environment as indexed by birth cohort over a period of rapid changes in family norms during the twentieth century. Interestingly, we find evidence that the complexity of fertility and differentiated family trajectories decreased across cohorts, but we find no evidence that the heritability of the complexity of partnership trajectories changed across cohorts. Therefore, our results do not substantiate claims that lower normative constraints on family demographic behavior increase the role of genes.
PMID: 34251430
ISSN: 1533-7790
CID: 4951072
Baseline brain function in the preadolescents of the ABCD Study
The Adolescent Brain Cognitive Development (ABCD) Study® is a 10-year longitudinal study of children recruited at ages 9 and 10. A battery of neuroimaging tasks are administered biennially to track neurodevelopment and identify individual differences in brain function. This study reports activation patterns from functional MRI (fMRI) tasks completed at baseline, which were designed to measure cognitive impulse control with a stop signal task (SST; N = 5,547), reward anticipation and receipt with a monetary incentive delay (MID) task (N = 6,657) and working memory and emotion reactivity with an emotional N-back (EN-back) task (N = 6,009). Further, we report the spatial reproducibility of activation patterns by assessing between-group vertex/voxelwise correlations of blood oxygen level-dependent (BOLD) activation. Analyses reveal robust brain activations that are consistent with the published literature, vary across fMRI tasks/contrasts and slightly correlate with individual behavioral performance on the tasks. These results establish the preadolescent brain function baseline, guide interpretation of cross-sectional analyses and will enable the investigation of longitudinal changes during adolescent development.
PMID: 34099922
ISSN: 1546-1726
CID: 4950912
