Faculty Bibliography

Non-suicidal self-injury (NSSI) is a complex and often misunderstood behavior linked to emotional dysregulation, trauma, and substance use. In this case report we present a 19-year-old female with a history of childhood trauma and substance use, who engaged in self-injurious behavior as a coping mechanism to manage distress and maintain sobriety. Through her narrative and clinical course, we explore the multifaceted drivers of NSSI, its diagnostic considerations, and therapeutic interventions including dialectical behavior therapy. This case report underscores the importance of trauma-informed, individualized care and highlights emerging insights into the neurobiological underpinnings of self-injury. This case advocates for early recognition, compassionate engagement, and integrated treatment approaches to support recovery.

INTRODUCTION/UNASSIGNED:The furosemide stress test (FST) is used to assess urine flow rate (UFR) after a furosemide bolus. FST predicts severe acute kidney injury (AKI) and renal replacement therapy (RRT) receipt in adults, with limited data in pediatric intensive care unit (PICU) patients. We implemented AKI risk stratification using the renal angina index (RAI) with urine neutrophil gelatinase-associated lipocalin (uNGAL) to guide FST in high-risk children but have not evaluated outcomes. METHODS/UNASSIGNED:We combined 2 prospective, observational studies of high AKI risk PICU patients (RAI+: ≥ 8, uNGAL+: ≥ 150 ng/ml). We compared patients who underwent FST (≥ 0.75 mg/kg i.v. furosemide) in the first week versus those who did not, and FST responders (≥ 3 ml/kg/h UFR over 4 hours) versus nonresponders. We examined UFR's predictive performance for new or persistent severe AKI or RRT receipt 2 days later. RESULTS/UNASSIGNED:< 0.001]) with optimal cutoff < 1 ml/kg/h (PPV: 68%, NPV: 86%). UFR predicted RRT receipt in patients with stage 3 AKI with similar test characteristics. CONCLUSION/UNASSIGNED:FST is used inconsistently in high AKI risk children but has prognostic utility for new or persistent severe AKI, including RRT receipt, independent of AKI stage.

BACKGROUND/OBJECTIVES/UNASSIGNED:Emotional fear memories are increasingly recognized as contributors to the development of specific fears and phobias. Despite this, relatively little dental fear research has specifically focused on patient memories or their potential role in the etiology of dental fear. METHODS/UNASSIGNED:This two-study paper employs qualitative thematic analysis of memories for dental visits among traumatized patients (study 1) and the general patient population (ranging from endorsing no dental fear to severe fear). Recollections were evaluated based on the characteristics (i.e., sensory descriptors, affectively laden, intrusive) of emotional fear memories (studies 1 and 2) and according to a modified cognitive vulnerability model of dental fear (study 2). RESULTS/UNASSIGNED:Characteristics of emotional fear memories were ubiquitous across recollections of individuals who endorsed traumatic dental visits in childhood. Among the general patient population, these characteristics and cognitive vulnerability themes (particularly perceptions of the visit and dentist as dangerous and untrustworthy) were more prevalent in the earliest remembered visits for fearful individuals. When individuals were asked to recall their worst dental visits, emotional fear memory characteristics and vulnerability perceptions were evident across the spectrum of current fear (none to severe). CONCLUSIONS/UNASSIGNED:This study contributes to nascent work examining memory in specific fears and phobias and suggests that worst recollections across a general sample share many of the characteristics that might otherwise imply vulnerability for anxiety. We recommend that dental practices universally screen patients for fear, inquire about past negative experiences, partner with patients to minimize evoking their specific vulnerabilities, and diligently implement these personalized care plans.

BACKGROUND:Metabolic syndrome is a pressing public health issue and risk factor for the development of type 2 diabetes (T2D) and cardiovascular disease (CVD), yet clinical practice is lacking in biomarkers that represent pre-clinical perturbations of the heterogenous subtypes of risk. This study aimed to characterize the baseline metabolome in relation to known clinical characteristics of risk in a sample of obese adults. METHODS:Untargeted metabolome data from N = 126 plasma samples with baseline data from a previously completed study including obese adults with metabolic syndrome. Metabolites were acquired using validated liquid chromatography mass spectrometry methods with 15-25 internal standards quantified by peak heights. Pearson's correlations were used to determine relationships between baseline metabolites, sample characteristics (e.g., age, body mass index (BMI)), and atherosclerotic clinical characteristics (e.g., high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides), adjusting for multiple comparisons using the Benjamini-Hochberg False Discovery Rate (FDR) method. Differences in metabolite levels between clinical classifications of dysglycemia (e.g., normal, prediabetes, diabetes) at baseline were assessed using ANOVA and adjusted for multiple comparisons and adjusted for covariates. RESULTS:The sample consisted primarily of female (74%) participants, predominantly white (70%), with an average age of 56 years. After FDR adjustment, two baseline metabolites were significantly associated with age (xylose, threitol), two with BMI (shikimic acid, propane-1,3-diol), one with LDL (tocopherol-alpha), and 42 with HDL cholesterol. Three metabolites were significantly associated with fasting blood glucose (FBG) levels at baseline (glucose, gluconic acid lactone, pelargonic acid). CONCLUSIONS:This study identified novel metabolite associations with known markers of T2D and CVD risk. Specific metabolites, such as alpha-tocopherol, branched-chain amino acids (BCAAs), and sugar-derived metabolites like mannose and xylose, were significantly associated with age, BMI, lipid profiles, and glucose measures. Although most sample participants had normal HDL cholesterol at baseline, 42 metabolites including branched chain amino acids were significantly associated with HDL, suggesting pre-clinical perturbations in biological pathways associated with both diabetes and cardiovascular comorbidities. Metabolomic signatures specific to prediabetes and metabolic syndrome can enhance risk stratification and enable targeted prevention strategies for T2D. Longitudinal studies are needed to understand how these associations change over time in at-risk individuals compared with controls.

AIMS/UNASSIGNED:Myocardial infarction size is associated with mortality in ST-elevation myocardial infarction (STEMI). With advances in primary percutaneous coronary intervention (PPCI) and medical therapy, whether this relationship has changed over time is unclear. METHODS AND RESULTS/UNASSIGNED:= 0.180). CONCLUSION/UNASSIGNED:We observed an independent relationship between infarct size and STEMI mortality, strongest between 2005 and 2009, which reduced over time, becoming non-significant in the 2015-19 period. This association diminished more rapidly for patients with anterior STEMIs. These findings underscore the potential role of contemporary revascularization, systems of care, and guideline-directed medical therapy in reducing STEMI-related mortality.

PURPOSE/OBJECTIVE:This study sought to investigate the prevalence and sociodemographic determinants related to breast and cervical cancer screening among ever-married women aged 15 to 49 years in Jordan. METHODS:This research employed secondary data from the 2023 Jordan Population and Family Health Survey (JPFHS), which included 12,547 ever-married women aged 15 to 49. Weighted multivariable logistic regression analyses were conducted to quantify screening prevalence and identify related covariates, presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS:The prevalence of screening for breast and cervical cancer was 15.2% and 16.2%, respectively. Increased screening participation was substantially correlated with advanced age, larger home affluence, higher parity, previous sexually transmitted infections (STIs), and exposure to radio communications. Women aged 35-49 were more likely to receive breast (AOR: 4.0; 95% CI: 2.6-6.0) and cervical cancer screening (AOR: 5.5; 95% CI: 3.3-9.2) compared to those aged 15-24 years. Women in the highest wealth quintile had a greater likelihood of being screened for breast cancer (AOR: 2.1; 95% CI: 1.6-2.8) and cervical cancer (AOR: 2.6; 95% CI: 1.9-3.5). Moreover, breast cancer screening correlated with recent healthcare service consumption (AOR: 1.3; 95% CI: 1.1-1.6), while cervical cancer screening had a favorable association with elevated educational attainment (AOR: 1.6; 95% CI: 1.2-2.3). Living in rural areas was inversely correlated with cervical screening participation (AOR: 0.7; 95% CI: 0.6-1.0).  CONCLUSION: Screening rates for breast and cervical cancer among Jordanian women are inadequate. Interventions that facilitate equitable access-especially aimed at younger, less educated, rural, and low-income women-are crucial for enhancing participation and diminishing inequities in early cancer detection.

Hemoglobinopathies and hemolytic anemias (HHA) are genetic blood disorders associated with diverse clinical complications, affecting an estimated 2.1 billion people worldwide. The World Health Organization (WHO) African Region accounts for approximately 425.8 million individuals, or 20% of the global HHA prevalence, yet comprehensive assessments of this burden have been lacking. We present the first systematic analysis of HHA burden in the WHO African Region from 2000-2021 using data from the Global Burden of Disease (GBD) 2021 study. We estimated regional, sex-, and age-specific rates (per 100,000 population) of mortality, incidence at birth, and years lived with disability (YLDs) in five-year intervals. Mortality estimates were generated using the Cause of Death Ensemble model (CODEm), supplemented with spatiotemporal Gaussian process regression. Incidence at birth was estimated using DisMod-MR 2.1, a Bayesian meta-regression tool, while YLDs were calculated by multiplying prevalence by disability weights reflecting severity and duration. Between 2000 and 2021, the WHO African Region experienced persistently higher age-standardized death rates from HHA compared to global levels, although regional mortality declined over the period. Sickle cell disorder (SCD) was the predominant contributor, with the highest mortality [3.68 deaths (95% UI 2.04-6.29) per 100,000] and disability burden [41.08 YLDs (95% UI 26.09-58.61)], while thalassemias contributed the least. Disability-adjusted life years (DALYs) were concentrated in western sub-Saharan Africa, accounting for 71.3% of the regional burden. Age-specific estimates revealed that children under five years faced a disproportionate share of mortality and disability. Despite overall declines in mortality, the WHO African Region continues to bear a disproportionate global burden of HHA, particularly affecting young children. These findings underscore the urgent need for strengthened newborn screening, early treatment, and health system interventions to reduce preventable deaths and disability.

PURPOSE/UNASSIGNED:The goal of this study is to report the feasibility and outcomes of hypofractionated proton reirradiation in patients with recurrent thoracic tumors. MATERIALS AND METHODS/UNASSIGNED:Data were retrospectively collected for patients who received hypofractionated proton therapy for recurrent lung cancer at a single facility. Proton reirradiation was delivered using a total of 15 fractions. Patient and tumor characteristics, adverse events, and dose-volume histogram parameters were collected and analyzed descriptively. Tumor control and patient survival were analyzed using Kaplan-Meier statistics. Univariate logistic regression was performed to analyze the relationship between dose-volume histogram parameters and acute and late toxicity. RESULTS/UNASSIGNED: = .041). CONCLUSION/UNASSIGNED:This study demonstrates the feasibility and efficacy of a hypofractionated course of proton reirradiation for recurrent thoracic tumors. DATA AVAILABILITY/UNASSIGNED:The data that support the findings of this study are available on request from the corresponding author.

INTRODUCTION AND IMPORTANCE/UNASSIGNED:Patients with ventricular arrhythmias (VAs) refractory to medical treatment suffer high morbidity and mortality. The stellate ganglion block is an effective diagnostic and therapeutic tool for refractory VAs. CASE PRESENTATION/UNASSIGNED:After obtaining an informed consent, we describe a case of a 62-year-old female who suffered ventricular tachycardia refractory to pharmacologic and electrical management, resulting in pulseless ventricular tachycardia (pVT) arrest. The regional anesthesia team was unable to expose the neck and obtain adequate ultrasound visualization using the classic approach and therefore used alternative ultrasound-guided approaches with success. DISCUSSION/UNASSIGNED:We describe the performance of the stellate ganglion blocks with an out-of-plane needle approach on the left and a medial in-plane approach on the right. These approaches allowed us to successfully block the stellate ganglia bilaterally. CONCLUSION/UNASSIGNED:Refractory VA is associated with an increased cardiac sympathetic tone and has high morbidity and mortality. Stellate ganglion blocks can be used for diagnostic and therapeutic purposes. In-plane and out-of-plane techniques can be utilized.