Faculty Bibliography

Background: Sodium bicarbonate therapy (SBT) has a variety of ED indications but its use is controversial. Some authors recommend SBT for drug overdoses involving salicylates and sodium channel antagonists such as tricyclics (TCA). Due to its effect on serum potassium, we hypothesized that SBT may prolong the QTc and increase risk for adverse cardiovascular events (ACVE). Our purpose was to evaluate SBT dose and duration in ED patients with drug overdose for an association with ACVE.
Method(s): We prospectively analyzed consecutive ED patients with acute drug overdose who were given SBT at two urban teaching hospitals from 2015-present. Data included SBT indication, dose, duration, and QTc (initial/peak from computer generated Bazett correction) during hospital stay. We used median values to dichotomize total dose (high/low) and total duration (long/short) of SBT. Patients were prospectively followed to hospital discharge for the occurrence of the primary outcome: ACVE and/or mortality. The previously validated definition of ACVE was used for in-hospital occurrence of any of these: ventricular dysrhythmia, myocardial infarction, shock requiring vasopressors, and cardiac arrest. Severe QTc prolongation was defined using the validated cutoff >=500ms. Ventricular dysrhythmias were adjudicated by a blinded cardiologist.
Result(s): Indications for SBT in 30 patients analyzed were: salicylism (5), sodium channel antagonist (6 TCA, 5 other), wide QRS in absence of known drug (9), acidosis or cardiac arrest (3), and unknown (2). After SBT, severe QTc prolongation occurred in 6 (20%), ACVE in 17 (57%), and 6 (20%) died. There was a significant association between severe QTc prolongation in-hospital for both high dose and long duration groups (p<0.05 for both). There was a significant correlation between both SBT dose (83% high, 38% low, p < .05) and SBT duration (100% long, 25% short, p < .05) with the primary outcome.
Conclusion(s): ED patients with acute drug overdose receiving SBT had very high rates of mortality and ACVE, which were strongly associated with higher dose and longer duration of SBT. Severity of overdose was a limitation to interpretation as a potential confounder. Overall, these results are consistent with the hypothesis that SBT prolongs the QTc and increases risk for ACVE, validating previous safety concerns regarding the administration of SBT for drug overdose

BACKGROUND/AIM/OBJECTIVE:National guidelines offer little guidance on the use of PSA progression (PSA increase as defined below) as a clinical endpoint in metastatic castration-resistant prostate cancer (mCRPC). The aim of the study was to examine treatment patterns/outcomes with abiraterone (abi)/enzalutamide (enza) throughout PSA progression and near the end of life (EOL). PATIENTS AND METHODS/METHODS:Cases of mCRPC treated with abi or enza from the New York Veterans Affairs (VA) from 6/2011-8/2017 were reviewed. Regression analyses were conducted to identify factors associated with continuation of abi/enza treatment up to the EOL, and survival. RESULTS:Of 184 patients, 72 received abi alone, 28 received enza alone, and 84 received both. Treatment was changed for PSA progression alone in 39.1% (abi) and 25.7% (enza) of patients. A total of 37 patients (20%) received abi/enza within 1 month before death, 30% of whom were receiving hospice services. Older patients and black patients were less likely to receive abi/enza up to the EOL. CONCLUSION/CONCLUSIONS:Abi/enza are frequently discontinued for PSA progression alone and continued at EOL. The clinical benefit of these practices warrants additional study.

Background/UNASSIGNED:(the gene encoding RAGE), have been reported to be associated with T2D and its complications, we tested for potential relationships between these factors and T2D status in Emirati subjects. Methods/UNASSIGNED:In a case-control study, we recruited Emirati subjects with T2D and controls from the Sheikh Khalifa Medical City in Abu Dhabi. Anthropomorphic characteristics, levels of plasma sRAGE and esRAGE, and routine chemistry variables were measured. Results/UNASSIGNED: = 0.01, after adjustment for age and sex). Conclusion/discussion/UNASSIGNED:Levels of sRAGE, but not esRAGE, were associated with T2D status in Abu Dhabi, but not after correction for eGFR. Elevated levels of plasma insulin in both control and T2D subjects suggests the presence of metabolic dysfunction, even in subjects without diabetes.

This study evaluates how teacher report measures align with different conceptualizations of children's social-emotional development. Leveraging seven teacher report measures of social competence and behavioral regulation in a predominantly low-income, population-based rural sample of four-year-old children (n = 828), model fit and validity were evaluated in a series of confirmatory factor models, including bifactor models. A bifactor model with behavioral regulation as a general factor and an orthogonal social competence factor emerged as the preferred model. Results indicate that teacher reports of behavioral regulation capture teachers' perceptions of preschoolers' behavioral regulation. However, teacher reports of social competence reflect teachers' perceptions of both social competence and behavioral regulation. Post-hoc analyses were conducted to explore potential explanations for these findings. Implications for interpreting teacher reports of social-emotional development and for future work strengthening the quality of scalable measures of children's social-emotional development are discussed.