Faculty Bibliography

Introduction: Inflammatory bowel disease (IBD), comprised of Ulcerative Colitis (UC) and Crohn's Disease (CD), is caused by a combination of environmental factors, immune dysregulation, and genetic susceptibility. Other immune-mediated phenomena, like hypothyroidism, have also been observed in this population. Thus, we sought to explore clinical characteristics and outcomes among IBD patients with hypothyroidism compared to IBD patients without hypothyroidism.
Method(s): In a retrospective chart review from a large, tertiary, academic medical center, baseline demographics and clinical data were extracted for patients diagnosed with either UC or CD and having at least one thyroid stimulating hormone (TSH) measurement from prior to 2016. Based on the presence of a documented hypothyroidism ICD-10 code, patients were then divided into two groups, those with IBD alone and those with both IBD and hypothyroidism, as described in Figure. Individual charts were then further examined for disease characteristics, biomarkers, healthcare utilization, medication use, and other comorbidities from 2016 to 2022. Demographic and clinical variables were then compared between the two groups, as seen in Table.
Result(s): We identified 166 adult IBD patients (CD 53%, UC 47%). The mean age was 62.9 years. Among these patients, 116 patients (69.9%) had IBD and hypothyroidism. The most common causes of hypothyroidism were Hashimoto, subclinical, and acquired hypothyroidism. No differences were noted in race, smoking status, or BMI. IBD disease location, behavior, and prevalence of extra-intestinal manifestations did not significantly differ between the two study groups. Both groups had similar number of colonoscopies, hospitalizations, as well as comparable medication use (SSRI/SNRI, steroids, 5-ASA, immunomodulators, biologics). However, patients with IBD and hypothyroidism had higher rates of anemia (p=0.03), hypoalbuminemia (p=0.007), and CRP elevations (p=0.002). Furthermore, patients with both IBD and hypothyroidism had a greater median number of emergency department visits (p=0.039) and axial radiography (p=0.002).
Conclusion(s): IBD patients with hypothyroidism experience a more severe disease course with higher biomarkers of inflammation and healthcare utilization than those without hypothyroidism despite similar IBD phenotype and therapy exposures. This highlights a potential subgroup of IBD patients who may be at risk for increased disease severity and associated poor outcomes. (Table Presented)

Introduction: Nonalcoholic fatty liver disease (NAFLD) is causing an emerging global epidemic. The global burden of disease (GBD) study estimates the burden of NAFLD in 203 countries and geographic areas across the world, providing a unique opportunity to understand the landscape of this disease.
Method(s): Prevalence, mortality, and disability-adjusted life years (DALYs) of NAFLD from 1990 to 2019 by region and country in all sex and age groups were collected from the Global Health Data Exchange (GHDx) results tool (Available from http://ghdx.healthdata.org/gbd-results-tool). DALYs are the sum of years lost due to premature death and years lived with disability. The socio-demographic index (SDI) categorizes countries and geographic areas by development (low, low-middle, middle, high-middle, and high).
Result(s): Between 1990 to 2019, the global prevalence of NAFLD increased from 10.9% to 16.6% (increased by 52.6%; linear regression beta-coefficient 0.2, P < .001). In 2019, an estimated 1.3 billion people were affected by NAFLD worldwide. Mortality attributed to NAFLD increased from 93,000 to 169,000. DALYs of NAFLD increased from 2.7 million years to 4.4 million years. Significant uptrends were observed in all SDI regions, more prominent in the middle SDI regions (Table). Changes in the prevalence of NAFLD by countries are depicted in Figure. All but three countries demonstrated an increase in the prevalence of NAFLD. More notable increases (>=10%) were mostly observed in North African and Middle Eastern countries.
Conclusion(s): NAFLD's prevalence increased by more than 50% globally from 1990 to 2019. The mortality and DALYs also increased. The increase in NAFLD prevalence is more prominent in countries with middle SDI and countries in North African and Middle Eastern regions, possibly due to changes in lifestyle in these areas over the past 30 years. (Figure Presented)

Introduction/UNASSIGNED:Platelet dysfunction and cardiovascular risk are well-recognized features of chronic kidney disease (CKD). Platelets drive the development and progression of cardiovascular disease (CVD). The relationships between kidney function, platelet activity, and cardiovascular risk are poorly defined. Methods/UNASSIGNED:) using data from the Platelet Activity and Cardiovascular Events study, a prospective cohort study that enrolled adults with peripheral artery disease (PAD) undergoing lower extremity revascularization. Platelet activity was measured using light transmission aggregometry (LTA) in response to submaximal dose agonist stimulation, and the subjects were followed for incident adverse cardiovascular events for a median of 18 months. Results/UNASSIGNED: < 0.05 for each). Following multivariable adjustment, subjects with CKD had elevated risk for myocardial infarction (MI) (adjusted hazard ratio 2.2, 95% confidence interval [1.02-4.9]) and major adverse cardiovascular events (MACE) (1.9 [1.2-3.3]) compared to those without CKD. Platelet aggregation in response to submaximal dose agonist stimulation mediated 7% to 26% of the excess risk for cardiovascular events associated with CKD. Conclusion/UNASSIGNED:Among subjects with PAD undergoing lower extremity revascularization, CKD is associated with increased platelet activity that mediates, in part, elevated cardiovascular risk.

OBJECTIVES/OBJECTIVE:Uncertain language in chest radiograph (CXR) reports for the diagnosis of pneumonia is prevalent. The purpose of this study is to validate an a priori stratification of CXR results for diagnosing pneumonia based on language of certainty. DESIGN/METHODS:Retrospective chart review. SETTING AND PARTICIPANTS/METHODS:CXR reports of 2,411 hospitalized patients ≥ 18 years, admitted to medicine, who received a CXR and noncontrast chest CT within 48 hours of emergency department registration at two large academic hospitals (tertiary and quaternary care) were reviewed. METHODS:test; a P value of .0031 was considered significant to account for multiple comparisons. RESULTS:CXR reports for the diagnosis of pneumonia revealed the following distribution: 61% negative, 32% uncertain, and 7% positive; CT reports were 55% negative, 22% uncertain, and 23% positive for the diagnosis of pneumonia. There were significant differences between CXR categories compared with CT categories for diagnosis of pneumonia (P < .001). Negative CXR results were not significantly different than the uncertain category with the most uncertain language (P = .030) but were significantly different from all other uncertain categories and positive results (each P < .001). Positive CXR results were not significantly different than the least uncertain category (most certain language) (P = .130) but were significantly different from all other categories (each P < .001). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Language used in CXR reports to diagnose pneumonia exists in categories of varying certainty and should be considered when evaluating patients for pneumonia.

 /UNASSIGNED:Fibromyalgia (FM) is a chronic pain disorder characterized by chronic widespread musculoskeletal pain (CWP), resting pain, movement-evoked pain (MEP), and other somatic symptoms that interfere with daily functioning and quality of life. In clinical studies, this symptomology is assessed, while preclinical models of CWP are limited to nociceptive assays. The aim of the study was to investigate the human-to-model translatability of clinical behavioral assessments for spontaneous (or resting) pain and MEP in a preclinical model of CWP. For preclinical measures, the acidic saline model of FM was used to induce widespread muscle pain in adult female mice. Two intramuscular injections of acidic or neutral pH saline were administered following baseline measures, five days apart. An array of adapted evoked and spontaneous pain measures and functional assays were assessed for three weeks. A novel paradigm for MEP assessment showed increased spontaneous pain following activity. For clinical measures, resting and movement-evoked pain and function were assessed in adult women with FM. Moreover, we assessed correlations between the preclinical model of CWP and in women with fibromyalgia to examine whether similar relationships between pain assays that comprise resting and MEP existed in both settings. For both preclinical and clinical outcomes, MEP was significantly associated with mechanical pain sensitivity. Preclinically, it is imperative to expand how the field assesses spontaneous pain and MEP when studying multi-symptom disorders like FM. Targeted pain assessments to match those performed clinically is an important aspect of improving preclinical to clinical translatability of animal models. SUMMARY/CONCLUSIONS:Preclinical assessments of chronic musculoskeletal pain recapitulate several outcome measures for clinical assessment of patients with FM, particularly prolonged spontaneous (resting) pain, and MEP.

BACKGROUND:During the first wave of the COVID-19 pandemic physicians worked on the front lines, immersed in uncertainty. Research into perspectives of frontline physicians has lagged behind clinical innovation throughout the pandemic. OBJECTIVE:To inform ongoing and future efforts in the COVID-19 pandemic, we conducted a qualitative exploration of physician perspectives of the effects of policies and procedures as well as lessons learned while caring for patients during the height of the first wave in the spring of 2020. DESIGN/METHODS:A confidential survey was emailed to a convenience sample. Survey questions included demographic data, participant role in the pandemic, and geographic location. Eleven open-ended questions explored their perspectives and advice they would give going forward. Broad areas covered included COVID-19-specific education, discharge planning, unintended consequences for patient care, mental health conditions to anticipate, and personal/institutional factors influencing workforce well-being amid the crisis. PARTICIPANTS/METHODS:We received fifty-five surveys from May through July 2020. Demographic data demonstrated sampling of frontline physicians working in various epicenters in the USA, and diversity in gender, race/ethnicity, and clinical specialty. APPROACH/METHODS:Inductive thematic analysis. KEY RESULTS/RESULTS:Four themes emerged through data analysis: (1) Leadership can make or break morale; (2) Leadership should engage frontline workers throughout decision-making processes; (3) Novelty of COVID-19 led to unintended consequences in care delivery; and (4) Mental health sequelae will be profound and pervasive. CONCLUSIONS:Our participants demonstrated the benefit of engaging frontline physicians as important stakeholders in policy generation, evaluation, and revision; they highlighted challenges, successes, unintended consequences, and lessons learned from various epicenters in the first wave of the COVID-19 pandemic. There is much to be learned from the early COVID-19 pandemic crisis; our participants' insights elucidate opportunities to examine institutional performance, effect policy change, and improve crisis management in order to better prepare for this and future pandemics.

LEARNING OBJECTIVES:After studying this article, the participant should be able to: 1. Understand the autologous graft options available to the rhinoplasty surgeon, including septal cartilage, auricular cartilage, costal cartilage, and bone. 2. Understand the autograft and allograft options available to the rhinoplasty surgeon, including cadaveric costal cartilage, silicone, Medpor, and Gore-Tex. 3. Identify the ideal situations to use each of these implant materials. 4. Understand the advantages and disadvantages of the different autografts, allografts, and implants in rhinoplasty. SUMMARY:This review focuses on the graft options available to the modern rhinoplasty surgeon. Autologous options are varied in the quality of cartilage harvested and the morbidity of the donor site. In addition, surgeons should understand the allograft options should autologous grafting be unfeasible or undesirable. New technological advances in processing of allograft cartilage makes this an attractive secondary option.