Inova Fairfax Hospital Research Articles

Advanced signet ring cell type gastroesophageal cancers in Latin American patients age 40 and below: A summary of one tertiary care center's experience and a review of the literature.

e16069 Background: Gastric Cancer mortality rates in Latin American countries of Central and South America (LA) are among the highest in the world. After observing multiple cases of advanced gastric adenocarcinoma (GA) with signet ring cell differentiation in young immigrants from LA, we sought to understand the prevalence and demographics of young-onset gastric cancer at our institution. Methods: We used the Inova Fairfax Hospital cancer registry to perform a retrospective cohort study by identifying all patients ≤ 40 from 2013-2022 with 1) GA, and 2) all cancers, and comparing the percentage of LA patients in each group. We noted a trend towards high rates of GC in young immigrants of LA six years ago, and now provide an updated analysis. We then reviewed phenotypic characteristics of each tumor, including signet ring cell differentiation, Her-2/Neu overexpression, and H. Pylori status and the time interval between diagnosis and death. Results: From 2013-2022, 21/37 patients (56.8%) ≤ 40 with GA were from LA (Table 1), with the majority from El Salvador. 95% (20/21) of LA patients had tumors with signet ring cell morphology, 88% (14/16) of non-LA patients had tumors with signet ring cell morphology. In comparison, patients that self-identified as “Hispanic/Spanish” made up 8.1% of subjects ≤ 40 with all cancers during the same time period. Conclusions: At our tertiary care center, Stage IV signet ring cell gastric cancer is highly prevalent in young patients from Latin America. Further exploration of epidemiological risk factors is warranted. [Table: see text]

The Effect of the COVID-19 Pandemic and Lockdown on Operative Traumatic Brain Injury in Northern Virginia.

COVID-19 is a disease that causes flu-like symptoms and difficulty breathing. Emerging in 2019, the COVID-19 pandemic has affected the entire world through restrictions and lockdowns. Multiple studies have compared the effects of COVID-19 on different types of head trauma, with each one producing different results. The goal of this study was to use state and hospital data to determine whether the COVID-19 pandemic had a significant impact on surgeries for traumatic brain injury (TBI). Public state data on COVID-19 incidence, sourced from the Virginia Department of Health, was compared to hospital data of 352 patients receiving surgeries for TBI from a single major level-one trauma hospital in Northern Virginia. We used data from the three years before COVID-19 and the two years during the pandemic, using t-tests and Pearson correlation to analyze the data. This is a retrospective case review study on the number and age of patients receiving TBI surgery from March 2017 through February 2022 at Inova Fairfax Hospital in Northern Virginia to determine the impact of the COVID-19 pandemic on these factors. When comparing the data, there was a 60% reduction in cases of operative TBI during the peak months of COVID-19 compared to the same months in previous years (p<0.005). Comparing data on the number of Virginia and Northern Virginia COVID-19 cases and data on the age of individuals undergoing TBI surgery four weeks later showed a statistically significant negative correlation (p<0.05) in which the average age of individuals undergoing TBI surgery was lower in the four-week block following a four-week block of increased COVID-19 incidence. Our findings indicate a correlation between the period of decreased activity from COVID-19 restrictions in Virginia and a decline in both the number of TBI surgeries and the age of individuals undergoing these surgeries.

Provider-Only Patients: A Novel Approach to ED Volume Surge and Covid-19

Summary To address changes in the health care landscape precipitated by the Covid-19 pandemic, particularly the lack of health care personnel, the ED at Inova Fairfax Hospital developed a process to evaluate and treat patients under a Provider-Only Patients (POP) protocol involving only physicians or advanced practice providers (APPs). In this article, Inova reports on the development of the POP process and the outcomes of a cohort of patients with suspected Covid-19 who were seen in the ED as POP patients between December 1, 2021, and January 15, 2022. All of the POP patients had Covid-19–related complaints, had an Emergency Severity Index (ESI) of 4 or 5 (on a scale where 1 is most urgent and 5 is least urgent), required limited nursing intervention, were discharged, and were 21–64 years of age. Any patients who exhibited signs of hemodynamic instability (e.g., hypo- or hypertensive), had non–Covid-19 complaints, had room air oxygen saturation below 96%, were pregnant, had difficulty ambulating, and/or had inadequate social support were not considered to be a POP patient and were seen in the regular queue of patients. Inova developed a designated area in the ED where patients were seen and discharged directly by the provider. Patients were first triaged by a triage nurse or physician to determine POP status. As of January 2022, Inova’s ED had seen 640 POP and 2,386 non-POP ESI 4 and 5 subjects (4.4% of the total ED census). Although the mean time from ED arrival to bed favored non-POP patients by approximately 9 minutes, the mean time from initially being seen by a provider to the discharge disposition and the mean time from discharge disposition placement to leaving the ED significantly favored POP by 48 minutes and 66 minutes, respectively. No POP patients returned within 72 hours for admission to the hospital, which supports the integrity of the POP triage and care delivery process. The authors estimate that the 640 patients who were part of the POP process saved approximately 1,892.27 nursing and 705.1 provider hours during that 46-day study period. No additional physician or APP hours were required, which suggests that POP is a safe, efficient, and effective process that can significantly reduce provider-to-disposition times and overall discharge length of stay. In addition to its value in mitigating the pandemic-related staff shortage, the POP model may also be considered to address nonpandemic-related staffing challenges.

Sessions Reflect Intersection of New Orleans History and Plight of Vulnerable Citizens

Sessions Reflect Intersection of New Orleans History and Plight of Vulnerable Citizens

Abstract 10637: A Pooled Multi-National Validation Study of a Machine Learning, High-Sensitivity Troponin-Based Multi-Proteomic Model to Predict the Presence of Obstructive Coronary Artery Disease as Compared to High Sensitivity Troponin Alone in a Subset of Patients with Diabetes

Introduction: Diabetes Mellitus (DM) is a major risk factor for coronary artery disease (CAD) associated with a two-fold increase in mortality. We aimed to validate the performance of a machine learning based multi-biomarker diagnostic panel to predict obstructive coronary artery disease (oCAD) compared to high-sensitivity cardiac troponin-I (hs-cTnI) alone in a subset of patients with DM. Methods: A previously developed multiple biomarker scoring model was utilized. The pooled cohort included 132 patients at Inova Fairfax Hospital, 69 patients at Massachusetts General Hospital and 46 patients at the University Hospital Hamburg-Eppendorf with a mixture of acute and lesser acute presentations. Three clinical factors (sex, age, and previous coronary percutaneous intervention) and three biomarkers (hs-cTnI, Adiponectin, and Kidney Injury Molecule-1) were combined. oCAD was defined as &gt;50% coronary obstruction in at least one coronary artery (for the University Hospital Hamburg-Eppendorf cohort) or &gt;70% coronary obstruction in at least one coronary artery (for the other two cohorts). The multiple biomarker diagnostic panel’s performance to predict oCAD was also compared to hs-cTnI alone. Results: The multiple protein panel had an area under the receiver-operating characteristic curve of 0.77 (95% CI, 0.70, 0.84, p &lt;0.001) for the presence of oCAD (Figure 1). At optimal cutoff, the score had 79% sensitivity, 57% specificity, and a positive predictive value of 81% for oCAD. The multiple biomarker panel had a diagnostic odds ratio of 4.82 (95% CI 2.68, 8.67, p&lt;0.01). In comparison, in patients without an acute MI, hs-cTnI alone had an area under the receiver-operating characteristic curve of 0.53 (95% CI, 0.49, 0.57, p = 0.253) for oCAD (Figure 1). Conclusions: In this multinational pooled cohort, a previously described novel machine learning, multiple protein biomarker panel provided high accuracy to diagnose patients for oCAD in a subset of patients with DM.

Editorial introductions

Editorial introductions

Understanding the Breadth and Depth of C-L Psychiatry: Assessing and Managing Delirium

Understanding the Breadth and Depth of C-L Psychiatry: Assessing and Managing Delirium

2020 Annual Meeting Course Section: Why a Course?

Back to table of contents Next article APA & MeetingsFull Access2020 Annual Meeting Course Section: Why a Course?Catherine Crone, M.D.Catherine CroneSearch for more papers by this author, M.D.Published Online:10 Jan 2020https://doi.org/10.1176/appi.pn.2020.1b50AbstractWant an option for an intensive learning experience? Don’t want to fight the crowds when you head to a popular talk by a national or international expert? Want a chance to ask more than one brief question at the end of one of the many general sessions? Want an opportunity to talk to an expert, learn a new skill, or sharpen your current skills with the latest information? If you answer “yes” to any of these questions, then consider taking a course at APA’s Annual Meeting! These are four-hour, in-depth offerings on a wide variety of subjects including psychotherapy, cannabis, neuropsychiatry, global mental health, technology, forensic psychiatry, transcranial magnetic stimulation, and public speaking.Want something more? Try a master course, an eight-hour intensive learning experience that will hone your skills in areas such as psychopharmacology, motivation interviewing, suicide assessment, management of first-episode psychosis, and office-based buprenorphine treatment. Each of these includes receipt of an APPI-published book on the course’s topic by the experts teaching the master courses.Due to their popularity, courses fill fast, so don’t delay. Register for the Annual Meeting today and be sure to get a seat in your first-choice courses. ■Download the 2020 Annual Meeting Course Guide.Catherine Crone, M.D., is the vice chair in the Department of Psychiatry and Behavioral Sciences at Inova Fairfax Hospital. She is also a member of the Scientific Program Committee. ISSUES NewArchived

472. Rethinking the Role of Clindamycin for Toxin-Mediated Illnesses

BackgroundTreatment of toxin-mediated diseases such as toxic shock syndrome (TSS) and Staphylococcus scalded skin syndrome (SSSS) typically includes adjunctive clindamycin to halt bacterial exotoxin production. However, there is emerging clindamycin resistance in Staphylococcus aureus and Streptococcus pyogenes. We compared pathogen susceptibilities, clinical features, and outcomes of patients with toxin-mediated diseases to evaluate the role of adjunctive clindamycin in a contemporary setting.MethodsEpic was queried for patients < 18 years of age admitted to Inova Fairfax Hospital from January 1, 2009 to December 31, 2018. Patients were identified by ICD-9 and ICD-10 codes for TSS and SSSS and validated by manual chart review. TSS cases were classified as possible, probable, or confirmed, and SSSS cases were classified as probable or confirmed. Early antimicrobial use was defined as administration within the first 3 days of admission. Clindamycin, aminoglycosides, tetracyclines, and linezolid were considered antimicrobial agents with anti-toxin effect.ResultsThere were 32 cases of TSS, 38 cases of SSSS, and 1 case of bullous impetigo. S.aureus (30) and S.pyogenes (8) were the most common pathogens recovered with 1 case of MRSA. Vancomycin was given to 40 patients. 45% of S.aureus isolates were clindamycin resistant; no S.pyogenes isolates were clindamycin resistant. Fifty-eight patients received early anti-toxin agents: 51 received clindamycin, 4 received clindamycin and doxycycline, 1 received clindamycin and gentamicin, 1 received doxycycline, and 1 received gentamicin. 13 did not receive any early anti-toxin agent. 42% of patients who received early clindamycin had a clindamycin-resistant S. aureus. The presenting features, number of TSS and SSSS cases, need for intensive care, median length of stay, and 30-day readmissions did not significantly differ based on early anti-toxin agent use or based on clindamycin susceptibility. There were no deaths.ConclusionWithholding anti-toxin agents early in the course of illness or giving clindamycin to a resistant organism in toxin-mediated diseases did not adversely affect patient outcomes or mortality. Opportunities remain to decrease the use of empiric vancomycin and re-evaluate the role of clindamycin for toxin-mediated diseases.Disclosures All authors: No reported disclosures.

WBC COUNT AS A PROGNOSTIC INDICATOR IN THE TREATMENT OF IDIOPATHIC PULMONARY FIBROSIS

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a progressive form of interstitial lung disease resulting in varying degrees of scarring that is further exacerbated by acute inflammatory processes. White blood cell (WBC) count has been established as an inflammatory marker and is a known prognostic indicator in several cardiopulmonary processes. For IPF patients on disease-modifying therapy such as nintedanib or pirfenidone, the correlation between WBC and disease-related events has not been well studied. METHODS: Patient demographics, complete blood cell (CBC) counts, and pulmonary function tests from patients with IPF evaluated at Inova Fairfax Hospital between October 2014 and January 2019 were collected. CBCs were compared before and after initiation of anti-fibrotic therapy. Outcome events collated were respiratory hospitalizations, lung transplant, or death following the initiation of anti-fibrotic therapy. Event-free survival was calculated and compared between patients on nintedanib versus pirfenidone. RESULTS: Sixty-one patients with IPF had CBCs available prior to initiation of anti-fibrotic therapy. WBC range was 3.5 to 16.0 (median 8.0). Subsequently, 28 patients had been started on pirfenidone and 33 patients had been prescribed nintedanib. Of the 61 patients, those with baseline WBC count less than 8 (N=32) had a median event-free survival of 710 days (P=NS) compared with 703 days (P=NS) for those with baseline WBC count greater than 8 (N=29). The median change in WBC count amongst the 61 patients was -0.3. Median event-free survival for those with an increase in WBC count (N=23) after initiating anti-fibrotic therapy was 683 days (P=NS) compared with 761 days (P=NS) for those with no change or a decrease in WBC count (N=38). CONCLUSIONS: Trending the change in WBC count in patients with IPF on anti-fibrotic therapy did not serve as a prognostic indicator with statistical significance. This result may have been influenced by the small sample size of the study. Additionally, although WBC count has been suggested as a biomarker of prognosis in IPF, the mechanism of action of anti-fibrotic therapy may be independent of factors that influence the WBC count. CLINICAL IMPLICATIONS: Based on the findings of this study, further research is indicated to investigate the potential significance of WBC count and its role in inflammation in the evolution of IPF and its management. DISCLOSURES: No relevant relationships by Scott Barnett, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 Added 03/15/2019 by Anne Brown, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Anne Brown, source=Web Response, value=Consulting fee No relevant relationships by Talha Demirci, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $1001 - $5000 Added 03/08/2019 by Christopher King, source=Web Response, value=Honoraria Consultant relationship with Roche-Genentech Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee

CONNECTIVE TISSUE DISEASE-ASSOCIATED INTERSTITIAL LUNG DISEASE AND OUTCOMES AFTER HOSPITALIZATION: A COHORT STUDY

SESSION TITLE: Characteristics of Interstitial Lung Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2018 02:30 pm - 03:30 pm PURPOSE: CTD-ILD, also known as connective disease (CTD) related interstitial lung disease (ILD), encompasses a wide group of autoimmune disorders that can lead to pulmonary fibrosis. The impact of hospitalization on patient outcomes in this population has not been well examined. METHODS: CTD-ILD patients with non-elective hospitalization greater than 1 day in duration between May 2012 and November 2017 at Inova Fairfax Hospital were identified. Baseline characteristics were collected. Hospitalization was classified as cardiopulmonary or other based on review of electronic medical record. Lung function and 6MWT performance was compared before and after hospitalization. Transplant-free survival was calculated and compared between cardiopulmonary and non-cardiopulmonary admissions using Kaplan Meier survival analysis. Confounding variables were controlled for using Cox proportional hazards modeling. SPSS was used for statistical analysis. RESULTS: Ninety-four patients met our inclusion criteria. Median age 59, BMI 27, and 68% were female. Twenty-nine percent had rheumatoid arthritis (RA), 22% scleroderma, 17% myositis-related, and 32% had other forms of CTD. Interestingly, FVC and 6MWT did not significantly change following cardiopulmonary hospitalization, but DLCO did (-5% with p = 0.02). Transplant-free median survival for the entire cohort was 2278 days (6.2 years), and those with RA showed the worst median survival at 337 days (p = 0.005). Transplant-free median survival for those with a cardiopulmonary hospitalization was significantly less than overall cohort at 1680 days (4.6 years) (p= 0.15). Those with scleroderma seemed most impacted by a cardiopulmonary hospitalization with a HR of death or transplant of 1.54; p = 0.62. Home oxygen use (HR= 2.10; p = 0.037) was associated with reduced transplant-free survival, while recent FVC (HR = 0.97; p = 0.007), African American race (HR = 0.45; p = 0.04) and female gender (HR = 0.47; p = 0.026) appeared protective. After adjusting for confounding variables of age, gender and home oxygen, cardiopulmonary hospitalization (H = 1.53; p = 0.33) appeared to be associated with worse outcomes compared to non-cardiopulmonary hospitalizations. CONCLUSIONS: Patients with CTD-ILD who require hospitalization have limited transplant-free survival; this is most pronounced for patients with RA. Cardiopulmonary hospitalization and use of home oxygen may be associated with poor outcomes after hospitalization. Further studies are needed to compare the prognosis in CTD-ILD patients who do not require hospitalization, in addition the impact of multiple hospitalizations. CLINICAL IMPLICATIONS: Hospitalizations appear to be associated with limited transplant-free survival, especially those cardiopulmonary in nature. Clinicians may use this information to have shared decision making with patients about escalation of treatment, transition to palliative care or urgency of transplant. DISCLOSURES: No relevant relationships by Karem Ahmad, source=Web Response No relevant relationships by Shambhu Aryal, source=Web Response No relevant relationships by A. Whitney Brown, source=Web Response Advisory Committee Member relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 03/03/2018 by Christopher King, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Bayer Pharmaceuticals Please note: $5001 - $20000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $5001 - $20000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Honoraria Advisory Committee Member relationship with Bellephoron Please note: $1001 - $5000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Gilead Sciences Please note: $1001 - $5000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Roche-Genentech Please note: $20001 - $100000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Honoraria Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with aTyr Pharma Please note: $1-$1000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Patara Pharma Please note: $1-$1000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Third Pole Please note: $1-$1000 Added 03/15/2018 by Steven Nathan, source=Web Response, value=Consulting fee No relevant relationships by Ankush Ratwani, source=Web Response No relevant relationships by Oksana Shlobin, source=Web Response No relevant relationships by Nargues Weir, source=Web Response

First Year Experience of a Quaternary Medical Center with Heart Failure Bundled Payment

Background: The Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative is an alternative payment model designed to link payments for multiple services received during an episode of care. The goal is to achieve higher quality and greater coordination of care at a lower cost to CMS. Inova Fairfax Hospital joined the BPCI Model 2 program for heart failure effective October 2015, assuming both upside and downside risk for a 90-day episode of care. Cost targets for each of the 3 heart failure MS-DRGs (291–293) were established based on 2009–2012 Medicare spending. Performance improvement initiatives included nurse navigators (inpatient and post-acute), enhanced order sets (ED, hospital, home health), physician documentation education, and skilled nursing facility network development. While our institution achieved cost savings during the first year, we sought to better understand the factors responsible for this success and opportunities for improvement. Methods: Eligible patients likely to be billed to a heart failure MS-DRG, excluding ESRD, were identified at admission and followed for 90 days post discharge. CMS paid claims were analyzed to study episode cost performance compared to baseline, including readmissions, skilled/acute rehab, home health, outpatient procedures, and home infusion therapies. Results: There were 298 episodes of care: 48.7% were billed MS-DRG 291 (high acuity) and 51.3% were billed MS-DRG 292 or 293 (low acuity). We successfully reduced skilled/acute rehab utilization from 30% to 23% and 90-day readmissions from 34% to 31%, achieving a 1% savings from our cost target. Overall, 73% of episodes were breakeven or favorable, with high acuity patients less likely to achieve savings compared to low acuity patients (64% vs 82%) and 7% of episodes exceeded target by a cost of $30,000 or more, with drivers including readmissions, extended skilled/acute rehab stays, elective TAVR, planned ICD implants or replacements, and high cost home infusion therapies. Conclusions: During the first year of participation, cost savings were primarily driven by reductions in skilled/acute rehab utilization and readmissions, while care for high acuity patients was more likely to result in economic losses. Quaternary referral centers participating in BPCI for heart failure are vulnerable to negative cost performance due to providing medically complex care for heart failure patients.

Advanced signet ring cell type gastroesophageal cancers in Central American patients age 40 and below: A summary of one tertiary care center's experience and a review of the literature.

e15515 Background: Gastric Cancer mortality rates in Central and South America are among the highest in the world. Our institution has monitored a cohort of patients who have presented with metastatic gastroesophageal cancer, age 40 or below. Methods: After observing multiple cases of advanced gastric cancer in young immigrants from Latin America, we performed a retrospective cohort study at Inova Fairfax Hospital, a 1000 bed tertiary care center in Northern Virginia. We reviewed our cancer registry from 2013-2016, to identify all patients, age 40 or below, with stage IV gastric adenocarcinoma. We also reviewed the percentage of hispanic patients in our cancer registry for all cancer diagnoses, for comparison. Results: There were thirteen patients with stage IV gastric cancer who were aged 40 or below found in our registry. Ten of the thirteen patients (76.9%) were from Latin America (see Table 1), with the majority of those being from either El Salvador or Honduras. All thirteen cases were notable for signet ring cell differentiation. Hispanic patients make up only 8.3% of the total subjects and 12.9% of gastric cancer subjects in the Inova Fairfax Hospital Cancer registry during that same time period. Conclusions: Stage IV signet ring cell gastric cancers have occurred frequently at our tertiary care center among young patients from Latin America. Further exploration of epidemiological risk factors is warranted. [Table: see text]

Ventricular Diastolic Pressure Ratio as a Marker of Treatment Response in Pulmonary Hypertension

Pulmonary hypertension (PH) is diagnosed and classified through right-sided heart catheterization, with a number of hemodynamic markers used to help guide treatment decisions. These markers may not reflect the complex remodeling of the right ventricle or the interplay between ventricles and struggle to predict treatment response. This study investigates the use of a novel marker: the ratio of left ventricular end-diastolic pressure to right ventricular end-diastolic pressure (LVEDP/RVEDP) in predicting treatment outcomes in a cohort of patients with PH. We performed a retrospective analysis of patients with PH at INOVA Fairfax Hospital's advanced lung disease program with simultaneous left-sided and right-sided heart catheterization. The primary end point was the time to clinical improvement, defined by an improvement in distance walked on the 6-min walk test (6MWT) of > 35m in a year without interceding hospitalization for worsening PH or the need for additional PH therapy. A total of 51 patients were included in the final analysis, 21 of whom (41.2%) had a salutary treatment effect with a mean improvement in the 6MWT of 75 m. Treatment responders were more likely to have a lower LVEDP/RVEDP ratio (1.08 vs1.62; P= .051). This association persisted in the final multivariate regression model after adjustment for age and sex and controlling for severity of PH (OR, 0.17; 95%CI, 0.03-0.65; P= .024). The LVEDP/RVEDP ratio is a novel marker for therapeutic response in patients with PH treated with pulmonary vasodilator medications and may offer robust predictive value independent of existing markers of disease severity.

Treatment of pulmonary hypertension in idiopathic pulmonary fibrosis: shortfall in efficacy or trial design?

Idiopathic pulmonary fibrosis (IPF) is a disease that carries a high mortality. Pulmonary hypertension (PH) frequently complicates the course of patients with IPF and is associated with significantly worse outcomes. Whether PH is a surrogate or driver of these worse outcomes remains unanswered, but the presence of PH represents an attractive target for therapy. This review delves into the various pulmonary vasoactive agents that have been subjected to study in IPF, the pitfalls of some of these prior studies, and attempts to lay a foundation for future study designs targeting PH in IPF.

Dr. Mohsen Ziai, the Internationally Renowned Professor of Universities in Iran and USA Passed Away

Copyright © 2013, Iranian Society of Pediatrics; Licensee Safnek Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Iranian Society of Pediatrics expresses its most sincere condolences on the occasion of this sad event to his kind wife, dear children, relatives and the esteemed family of the late professor Dr. Mohammad Garib, friends, and the venerable society of Iranian Medicine. On the event of this occasion a brief biography of Dr. Mohsen Ziai, his fruitful life and valuable services is presented here: Dr. Mohsen Ziai was born in Khorasan, the eighth generation of his family of doctors from Torbat-e-Heidarieh region. He was born in 1928 and passed away in April, 2013. He pursued his studies up to the end of high school in Torbat-e-Heidarieh, Mashhad and Tehran and went to Johns Hopkins University (Baltimore) for General Medicine courses. Specialty and subspecialty education in infectious diseases: Harvard University Books: Four books in the field of pediatrics are his memorable works. These four books are: 1)Pediatrics Text Book 2)Bedside Pediatrics 3)Neonatal Medicine 4)The Joys of Pediatrics In addition he published frequent essays in the field of health and hygiene and pediatrics training in famous, international medical journals. Membership in global associations and awards/honors achieved during service in USA. Honoury member of American Pediatric Society. Member of Mother/Child Experts Committee in WHO. Member of Pediatric Infection Disease Specialists. Membership of Alpha Omega Alpha Medical Honor Society. Honorary Fellow, American Academy of Pediatrics. Alumni Distinguished Achievement Award from Davis and Elkins College. Outstanding Faculty Teaching Award by the Pediatric House Staff University of Rochester, 1979. Third Year Outstanding Teacher Award, University of Rochester School of Medicine and Dentistry, 1981. Keith Miner Ford Award for Excellence in Teaching by the Graduating Class of 1982, The University of Rochester School of Medicine and Dentistry. Third Year Outstanding Teacher Award, The University of Rochester School of Medicine and Dentistry, Class of 1983. Honored by Rochester General House-Staff 1982 Teacher of the Year Award by the Pediatric House Staff, Georgetown University, 1983. Honored by Shiraz University Medical School Alumni Association 1989. Golden Apple Award by the Georgetown University School of Medicine, presented in 1985, 1987, 1988, and 1994. Golden Apple Orchard, 1988 and in 1994 selected beyond the Orchard; all presented by Georgetown University Medical Students. Teacher of the Year, Presented by Inova Fairfax Hospital for Children House-Staff, 1998, 2000. Honored by Iranian American Medical Association, 1998. Lifetime Achievement Award, Virginia Chapter, American Academy of Pediatrics, 2000. Samuel P. Asper Award in International Medical Education Presented by Johns Hopkins University, June 2001. Honorary Doctor of Science Degree/David & Elkins Collage, 31 March 2003. The late Dr. Mohsen Ziai, one of the genius figures of medicine in the world, provided exceptional and memorable services in Iran and USA. Among his substantial services in pediatrics are emphaArchive of SID

What to Do When Your Brain Turns Blue? Considerations During Aortic Arch Surgery

Expert Contributors Jenny Kwak, MD, is an assistant professor of anesthesiology at Loyola University Medical Center. Her interests include cardiothoracic anesthesia and resident echocardiography education. Hilary Grocott, MD, FRPC, FASE, is a professor of anesthesia and surgery at the University of Manitoba. He is also the Cardiac Anesthesia Fellowship Director at St. Boniface Hospital in Winnipeg, Manitoba. Cdr Darian Rice, MD, PhD, is the chief of cardiothoracic anesthesiology and residency program director at the Naval Medical Center, Portsmouth, Virginia. His interests include cardiothoracic and trauma anesthesiology, echocardiography, and resident education. Department of Defense disclaimer: The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Navy or the Department of Defense. David Fitzgerald, CCP, is the chief of cardiovascular perfusion at INOVA Heart and Vascular Institute and INOVA Fairfax Hospital for Children. Jeffrey Schwartz, MD, is an associate professor of thoracic and cardiovascular surgery at Loyola University Medical Center with an interest in complex aortic surgery. He is also the surgical director for the lung transplantation program and the residency program director for the cardiovascular surgery program.

Noteworthy Professional News

Inova Fairfax Hospital for Children, Falls Church, Virginia. Correspondence: Laura A. Stokowski, RNC, MS, Inova Fairfax Hospital for Children, 3300 Gallows Rd, Falls Church, VA 22042 ([email protected]). The author declares no conflict of interest.

Noteworthy Professional News

Inova Fairfax Hospital for Children, Falls Church, Virginia. Correspondence: Laura A. Stokowski, RNC, MS, Inova Fairfax Hospital for Children, 3300 Gallows Rd, Falls Church, VA 22042 ([email protected]). The author declares no conflict of interest.

Noteworthy Professional News

Inova Fairfax Hospital for Children, Falls Church, Virginia. Correspondence: Laura A. Stokowski, RNC, MS, Inova Fairfax Hospital for Children, 3300 Gallows Rd, Falls Church, VA 22042 ([email protected]). The author declares no conflict of interest.