Louisiana State University Health Sciences Research Articles

How can academic health science centers help to increase diversity in the STEM professions?

In the United States, great inequities exist within the science, technology, engineering, and math (STEM) fields in individuals who self-identify as belonging to underrepresented groups (e.g., from socioeconomically disadvantaged backgrounds, people with disabilities, and Black/African American, Hispanic/Latino, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander). Underrepresentation in STEM careers has been documented to be due to a lack of qualified and diverse teaching personnel, limited access to resources in disadvantaged schools, and implicit bias within US institutions. In recognition of these inequities, an interprofessional team of biomedical faculty members and diversity, equity and inclusion (DEI) educators from the Louisiana State University Health Science Center (LSUHSC) in New Orleans developed and implemented a STEM educational training pipeline for elementary, middle, and high school (K-12), undergraduate, and medical students, with accompanying DEI training for LSUHSC mentors and staff to mitigate implicit bias and promote a welcoming environment for participants from different backgrounds. Our findings focus on one social determinant of health: access and quality of education. Other institutions can implement a program as described in the present study to address the educational and health inequities in their own communities.

The Military Health History: An Educational Initiative to Improve Veteran Healthcare.

As a result of the nature of military service, veterans are a unique patient population with many special health considerations. For various reasons, measures are often not taken by clinicians to address such special considerations. This results in a healthcare disparity for veterans first described by Dr. Jeffrey Brown in 2012. To address this disparity, we introduced "the military health history" to third-year medical students at a large medical school in the southeastern United States. Our objective was to assess the effectiveness of this educational intervention and determine its potential role in creating a future in which veteran healthcare is of the highest quality. This study was approved as a quality assurance/quality improvement project by both Louisiana State University Health Science Center and Southeast Louisiana Veteran Healthcare System IRB offices. A short lecture outlining the components of the military health history was presented to 186 third-year medical students. The students were given the opportunity to answer five survey questions before and after the lecture. These questions assessed the students' current confidence performing a military health history, perceived importance of doing so, and likelihood of future implementation. To determine useful retention of the lecture material, the post-lecture survey was readministered to the same population sample 6 months after the lecture. A series of repeated measures analyses of variance were conducted to examine changes in mean levels of confidence, importance, and likelihood of ascertaining military history during a patient encounter at pre- and post-presentation as well as at the 6 month follow-up. Results revealed a significant effect of time on importance, Wilks' Lambda = 0.74, F (2, 87) = 15.41, P < 0.001; confidence, Wilks' Lambda = 0.61, F (2, 87) = 27.58, P < 0.001; and likelihood of ascertaining a military history during a future patient encounter, Wilks' Lambda = 0.46, F (2, 88) = 50.58, P < 0.001. Results are demonstrated in detail in Table I of the manuscript. The lecture resulted in a statistically significant increase over 6 months in both the likelihood and confidence parameters. The team believes that this result indicates that the students demonstrated useful retention of the lecture material. Our hope is that these students continue to employ the military health history throughout their years of clinical work. In the future, we plan to survey veterans immediately following Veterans Health Administration clinic visits with members of our study population to assess the patient's perceived benefit of the military health history. The team will continue to investigate ways in which military health curricula can be implemented in undergraduate medical education.

The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region.

The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma. This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated. Eight patients (mean age 55.8y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9cm 2 (range 17-85cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90d). Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.

An aerobic exercise intervention to improve metabolic health among people living with HIV with at-risk alcohol use: the ALIVE-Ex research study protocol

BackgroundEffective antiretroviral therapy (ART) in people living with HIV (PLWH) has improved life expectancy and increased risk of age-associated cardiometabolic comorbidities. At-risk alcohol use is more frequent among PLWH and increases the risk of health challenges. PLWH with at-risk alcohol use are more likely to meet criteria for prediabetes/diabetes and this is associated with impaired whole-body glucose-insulin dynamics.MethodsThe Alcohol & Metabolic Comorbidities in PLWH: Evidence Driven Interventions Study (ALIVE-Ex Study, NCT03299205) is a longitudinal, prospective, interventional study to determine the effects of an aerobic exercise protocol on improving dysglycemia among PLWH with at-risk alcohol use. The intervention is a moderate intensity aerobic exercise protocol implemented 3 days per week for 10 weeks at the Louisiana State University Health Sciences Center-New Orleans. Participants who have a fasting blood glucose level between 94 and 125 mg/dl will be enrolled in the study. Oral glucose tolerance tests, fitness assessments, and skeletal muscle biopsies will be performed pre- and post-exercise intervention. The primary outcome is to determine whether the exercise protocol improves measures of whole-body glucose-insulin dynamics, cardiorespiratory fitness, and skeletal muscle metabolic and bioenergetic function. Secondary outcomes are to determine whether the exercise intervention improves cognitive function and overall quality of life. Results generated will demonstrate the effect of exercise on glycemic measures in PLWH with subclinical dysglycemia and at-risk alcohol use.ConclusionsThe proposed intervention will also have the potential to be scalable to promote lifestyle changes among PLWH, particularly in underserved communities.

Demetrius Porche, DNS, RN, CS, FNP

Demetrius Porche is currently the Dean of Louisiana State University (LSU) Health Sciences Center School of Nursing (HSC SON) in New Orleans. Demetrius’ long and successful career has ranged from rebuilding the School of Nursing after Hurricane Katrina to leading national efforts to support both community and men’s health. He is a confident, innovative leader; a generous mentor; and a strong partner to nurse leaders in the practice arena. Among many volunteer leadership roles, Dr. Porche has served as president of the Louisiana State Board of Nursing, president of the American Assembly for Men in Nursing, member of the Governing Council of the American Public Health Association, and currently serves on the board of the American Association of Colleges of Nursing (AACN). Demetrius has been inducted as a fellow in the American Academy of Nurse Practitioners, the American Academy of Nursing, and National League for Nursing. He has been the associate editor of the Journal of the Association of Nurses in AIDS Care and currently is the chief editor of American Journal of Men’s Health. Demetrius Porche is currently the Dean of Louisiana State University (LSU) Health Sciences Center School of Nursing (HSC SON) in New Orleans. Demetrius’ long and successful career has ranged from rebuilding the School of Nursing after Hurricane Katrina to leading national efforts to support both community and men’s health. He is a confident, innovative leader; a generous mentor; and a strong partner to nurse leaders in the practice arena. Among many volunteer leadership roles, Dr. Porche has served as president of the Louisiana State Board of Nursing, president of the American Assembly for Men in Nursing, member of the Governing Council of the American Public Health Association, and currently serves on the board of the American Association of Colleges of Nursing (AACN). Demetrius has been inducted as a fellow in the American Academy of Nurse Practitioners, the American Academy of Nursing, and National League for Nursing. He has been the associate editor of the Journal of the Association of Nurses in AIDS Care and currently is the chief editor of American Journal of Men’s Health. Marla J. Weston, PhD, RN, FAAN, is chief executive officer at Weston Consulting LLC in Washington, DC. She can be reached at [email protected]

Judge rules against former medical resident

Case name: Logarbo v. Louisiana State University Health Sciences Center, et al., No. 22‐cv‐0831 (W.D. La. 12/14/22).

Impact of testosterone use on the vaginal microbiota of transgender men, including susceptibility to bacterial vaginosis: study protocol for a prospective, observational study

IntroductionThe effect of testosterone (T) therapy on the vaginal microbiota of transgender men (TGM) is not well characterised, although one cross-sectional study comparing the vaginal microbiota of cisgender women to...

2124. Active surveillance for Congenital Cytomegalovirus infections as part of institutional protocol for newborns with failed hearing screening

Abstract Background Congenital cytomegalovirus (cCMV) is the leading infectious cause of sensorineural hearing loss in newborns. Universal screening for cCMV is not recommended in the United States. It is important to establish effective strategies for early detection of newborns with cCMV, as most of them are asymptomatic at birth. Methods As per institutional protocol at Louisiana State University Health Sciences Center in Shreveport, every newborn who fails auditory brainstem response (ABR) hearing screen is referred to Audiology and is evaluated with CMV polymerase chain reaction (PCR) from urine samples to rule out cCMV before they are discharged home. We intended to evaluate the proportion of newborns failing hearing screening during a two-year period that are positive for CMV by urine PCR and that are referred to Pediatric Infectious Diseases for cCMV treatment. Results From January 1st, 2020, to March 6th, 2022, 4,010 newborns had ABR based hearing screening at birth, with 125 (3%) failing on two attempts. Subsequently, 85 of them, corresponding to 68%, passed repeat testing at Audiology clinic, while 25 did not show up for their appointments. Out of the 67 infants that passed repeat hearing test and were tested for cCMV, none had positive urine CMV PCR results. Among the 15 newborns who failed repeat hearing test in Audiology clinic, 2 (13%) had positive urine CMV PCR results, 9 had negative results and 2 infants did not have tests done (Figure 1). Both infants diagnosed with cCMV showed severe to profound sensorineural hearing loss and are being followed by Otorhinolaryngology. They are also receiving oral valganciclovir for cCMV infection with a plan to receive treatment for 6 months, being followed periodically by Pediatric Infectious Diseases. Evaluations with urine CMV PCR in newborns with repeat hearing screening showed that all 67 that passed were negative; and out of the 15 infants that failed repeat testing, 2 had positive CMV PCR results. Conclusion Our institutional protocol recommends sending urine samples for CMV PCR in every baby that fails newborn ABR hearing screen, and this has helped identified neonates with cCMV infections in the setting of severe to profound sensorineural hearing loss. These patients diagnosed with cCMV are planned to receive treatment for 6 months. Our future goals involve evaluating if early treatment of cCMV for 6 months can prevent progression of hearing loss and help achieving improved audiological outcomes at 2 years of age. Disclosures All Authors: No reported disclosures.

Upregulation of hnRNPC1/C2 expression in preeclampsia: a potential rationale for vitamin D insensitivity

Upregulation of hnRNPC1/C2 expression in preeclampsia: a potential rationale for vitamin D insensitivity Preeclampsia, a pregnancy-specific disorder in humans, is characterized by newly-onset maternal hypertension and proteinuria after 20 weeks of gestation. This pregnancy disorder complicates 5-8% of all pregnancies and is a leading cause of maternal and fetal morbidity and mortality worldwide. Preeclampsia is also a predisposing factor for cardiovascular and kidney diseases in women later in life. Although the etiology of preeclampsia is heterogenous, epidemiological studies revealed that vitamin D deficiency is a risk factor for preeclampsia development. Here, Drs Yuping Wang and David F. Lewis from Louisiana State University Health Sciences Center – Shreveport discuss hnRNPC1/C2 upregulation, a potential rationale for vitamin D insensitivity.

Book Review: Anatomical Guidelines for Temporal Bone Surgery. Second Edition: Miklos Toth; Budapest, Hungary: Appaloosa Communication Group Ltd., 2019.

Division of Neurotology, Department of Otolaryngology, Louisiana State University Health Sciences Center, Baton Rouge and New Orleans, Louisiana [email protected] Sources of support and disclosure of funding: None. The author discloses no conflicts of interest.

Book Review: Tinnitus: Advances in Prevention, Assessment, and Management. Authors: Aniruddha K. Deshpande and James W. Hall III; San Diego, CA: Plural Publishing Inc., 2022.

Louisiana State University Health Science Center, Our Lady of the Lake Hearing and Balance Center, Baton Rouge, Louisiana; Culicchia Neurological Clinic, New Orleans, Louisiana

Outcome of repairing posterior interosseous nerve (PIN) injury

Abstract Introduction: The posterior interosseous nerve (PIN) is the terminal branch of the deep branch of the radial nerve. It providing movement for the posterior forearm, controlling extension of the wrist and fingers. PIN injury severely affects hand function so it should be diagnosed and repaired promptly. Microsurgical repair of the PIN will recover the best results. The purpose of this study: evaluate the efficient of repairing posterior interosseous nerve by microsurgery. Patients and methods: Retrospective and prospective study base on 21 patients with PIN injury who was performed microsurgery repair from 2018 to 2022. Assessment of recovery outcomes by using The Louisiana State University Health Science grading system - 2020 (LSUHS) and classified into 3 groups: Good (grade 4, 5); Fair (grade 3. 2); Poor (grade 0. 1). Results: There are 14 men and 7 women, aged from 6 to 47. Cause by wounds: 12/21 cases, after previous surgery: 7/21 cases, nerve compression: 2/21 cases. Direct repair (nerve grafting): 20/21 cases, end-to-end neurorrhaphy were performed in: 1/21 case. Time follow-up ranged from 3 months to 60 months. Results: Good: 17/21 (80.95%) cases; Fair: 5/21 (19.05%) cases; Poor: no cases. Conclusion: As results: Good: 17/21 (80.95%) cases; Fair: 5/21 (19.05%) cases; Poor: no cases. PIN injury severely affects hand function, so it should be diagnosed and repaired promptly by microsurgery. Keywords: Posterior Interosseous Nerve, Nerve injury, Microsurgical peripheral nerve

Trends in drug use among young adult females: a 22-year retrospective analysis

Louisiana State University Health Sciences Center at Shreveport (LSUHSC-S) serves a largely minority-based, urban population. This study aims to identify trends in urine drug screen (UDS) results among females aged 18–35 visiting State University during 1998–2011 and 2012–2019. Using two databases extracted from the electronic medical record system, we performed statistical analysis of demographics and UDS results. Young females aged 18–35 mostly tested positive for cannabinoids and opiates during both periods, 1998–2011 and 2012–2019. African-American females had a higher percentage of positive UDS for illicit drugs, such as cannabinoids and cocaine, while Caucasian females had a higher rate for prescription drugs such as opiates, benzodiazepines, and amphetamine. Between 1998–2011 and 2012–2019, trends in drug screen results changed in both populations, with Caucasian females showing a drastic increase in amphetamines and African-American females showing increase in opiates and cannabinoids during 2012–2019. GatewayNet analysis (sequential-rule mining for inducing causation) for 2012–2019 indicated that a positive screen for amphetamines is likely preceded by a positive screen for cannabinoids, and benzodiazepines may be preceded by opiates. Our results emphasize the importance of drug use monitoring among young females of childbearing age. GatewayNet analysis implies a sequential nature to drug positivity on urine drug screening in this population.

The COVID-19 pandemic and associated increases in experiences of assault violence among black men with low socioeconomic status living in Louisiana

BackgroundThe COVID-19 pandemic has had mental health, social, and economic implications among communities with high levels of social disadvantage; this may have impacted community violence rates. The objective of this study was to characterize overall trends in assault and social disadvantage of patients experiencing assault before and during the COVID-19 pandemic. MethodsAll trauma activations at a level one trauma center serving the entire southeast Louisiana region were included during March–August pre-COVID (2018–2019) and during COVID (2020). ICD-10 E-codes were used to identify trauma intent (assault vs. other). Assaults in this context are defined as physical injuries caused by an act of violence wherein the perpetrator was suspected or confirmed to have intended harm, injury, or death to the victim. Social disadvantage was assessed using the Area Deprivation Index (ADI). Change in the monthly rate of assault-trauma activations was assessed using negative binomial regression with adjustment for race, gender, and injury intent. The study was reviewed and approved by the Louisiana State University Health Sciences Institutional Review Board. ResultsA total of 4,233 trauma activations were included. The majority of activations occurred among men. Assaults increased from 27.5% of all activations pre-Covid to 35.6% during the pandemic. Penetrating trauma similarly increased from 29.5% to 35.7% of all activations. Negative binomial regression demonstrated that in addition to this increase in proportion of assaults relative to all activations, the monthly assault rate also increased by 20% during the pandemic. These increases were driven primarily by increased assaults among Black men. ADI rank did not change between study periods. ConclusionsHealth disparities in violence worsened during the pandemic: increased cases of assault occurred disproportionately among Black men, and assaults persisted in occurring primarily among low-ADI communities where burden had been high pre-pandemic. There is a critical need for resources and support to Black men, to mitigate violence and improve racial heath equity.

Abstract 231: Targeting CXCL17 (C-X-C Motif Chemokine Ligand 17) inhibits cutaneous squamous cell carcinoma via modulating angiogenesis

Abstract Cutaneous squamous cell cancer (cSCC) is one of the most rapidly increasing cancers in the USA, striking 200,000 Americans annually, and is associated with significant morbidity &amp; mortality. Exposure to Solar UVB (ultraviolet B) radiation is the primary etiologic factor for skin cancer. Sunscreens provide limited protection against UVB-induced skin cancer, and there is no effective adjuvant therapy for aggressive cSCC. Therefore, new mechanism-based approaches are needed for both prevention of cSCC and as adjuvant treatment for patients at high risk for recurrence and metastasis. Moreover, excision of cSCC of the Head &amp; Neck results in significant facial disfigurement, and thus, chemoprevention for patients with condemned skin is critical. Chemokine (C-X-C motif) ligand 17 (CXCL17) is the latest chemokine family member, and recent studies have identified both a causative and protective role of CXCL17 in tumorigenesis. The role of CXCL17 in the development and progression of cSCC is not yet elucidated. In our ongoing studies, CXCL17 protein expression was significantly overexpressed in cSCC cell lines (SCC12A, SCC118, SCC7, SCC59) compared to normal human epidermal keratinocytes. Deletion of CXCL17 significantly inhibited cSCC cell proliferation, migration, and motility, suggesting an essential role in tumor growth, invasion, and metastasis. Tumor-specific overexpression of CXCL17 was detected in human cSCC that further bolsters our in vitro findings, indicating a causative role for CXCL17 in skin tumorigenesis. Further, deletion of CXCL17 in cSCC cell lines was associated with marked downregulation of the AKT/mTOR/STAT3 cell signaling pathways. To translate our in vivo data in an in vivo animal model, the effect of CXCL17 deletion on cSCC tumor cell xenograft growth was evaluated. Deletion of CXCL17 in both non-metastatic and metastatic cSCC cells significantly decreased tumor growth. Moreover, the reduction in tumor growth was associated with a significant downregulation in tumor angiogenesis measured using IHC for CD31. Finally, using a retrospective chart review for patients at Louisiana State University Health Sciences Center Shreveport (LSUHSC-S) and Overton Brooks Veterans Affairs Medical Center, we investigated the correlation of CXCL17 staining in human cSCC tumor samples and clinicopathological factors associated with metastatic cSCC. Among 44 subjects included in the analysis, the Histo-score of cytoplasmic CXCL17 expression was significantly higher in the metastatic cSCC group compared to non-metastatic tumor samples. Interestingly, the CXCL17 staining score correlated with the perineural invasion, suggesting CXCL17 as a biomarker of aggressiveness. Our studies have established a causative role for CXCL17 in cSCC and a novel target in the treatment of cSCC Citation Format: Alok R. Khandelwal, Rema Anisha Kandula, Md Maksudul Alam, Janmaris Marin Fermin, Tara Moore-Medlin, John DiGiovanni, Cherie-Ann O. Nathan. Targeting CXCL17 (C-X-C Motif Chemokine Ligand 17) inhibits cutaneous squamous cell carcinoma via modulating angiogenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 231.

Early onset cardiovascular disease related to methamphetamine use is most striking in individuals under 30: A retrospective chart review

IntroductionThe illicit use of methamphetamine (MA), a dangerous psychostimulant has become a global epidemic. Studies have demonstrated a link between illicit substance use and cardiovascular consequences. The objective of this study was to assess whether MA use is associated with an early onset of cardiovascular diseases (CVD). MethodsRetrospective analysis was conducted using data collected from 1376 individuals at Louisiana State University Health Sciences Center - Shreveport between 2011 and 2020. Cardiovascular patients with and without a history of MA use were divided into the MA and Control groups. The age of CVD onset was assessed. Descriptive statistics for patient characteristics, Two Samples T-Test for continuous and Pearson's χ^2- tests for categorical variables were calculated. Hazard ratios (HR) and time ratios (TR) were calculated. ResultsThe age of CVD onset in patients with prior MA use occurred on average 8 year earlier than the age of CVD onset (mean age ± SD = 44 ± 12.04) in controls (mean age ± SD = 52 ± 10.70) (unpaired t-test, p < 0.0001). The findings were noted in both the races (Time Ratio = 0.93, 95% CI = 0.89 to 0.97, p-value < 0.001), with a striking difference in the latency to CVD onset between Black and White subjects. A 12-fold increase in subjects who showed a premature onset of CVD (<30 years of age) in the MA group was observed. Our data analysis revealed that hypertension was the most frequently observed CVD. ConclusionsMA use likely accelerates early onset of CVD and contributes to CVD complications in young adults.

TRANSPORTATION ACCESS AND DELAY IN DIAGNOSIS FOR PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS

Abstract PURPOSE Inflammatory bowel disease (IBD), consisting of both Crohn’s Disease (CD) and ulcerative colitis (UC), affects nearly 80,000 children in the United States. African American patients have more perirectal phenotype which might indicate more severe disease activity however it is unclear why. There is no published data on transportation access and how it relates to pediatric IBD. The purpose of this study is to compare pediatric IBD patients with low access to care to those with more access to care and their severity of disease at diagnosis. Our hypothesis is that those patients who live farther from the children’s hospital and bus stops will have more of a lag time in their diagnosis as defined by two or more visits with another provider for complaints concerning for IBD compared to those patients with more ease of access to care. We aim to assess the impact of proximity to care facilities, bus stops and primary children’s hospital and disease severity at the time of diagnosis for pediatric IBD population. METHODS This study is a retrospective chart review of patients seen by the Louisiana State University Health Science Center Pediatric Gastroenterology division at Children’s Hospital New Orleans from 2019 until 2021. A list of patients with the diagnosis of either CD or UC after 2019 was generated. Both qualitative and quantitative data was collected. Patient’s addresses were used to determine the distance to their primary gastroenterologist clinic. Data collected also included their proximity location to bus stops, number of visits prior to diagnosis of IBD. RESULTS There were 71 pediatric patients diagnosed during the study period. The patients were predominantly male (51%) and white (65%) with average age at diagnosis of 12 years old (± 3.3 years). Forty-eight (68%) patients were diagnosed with CD. More Crohn’s Disease patients had 2 or more visits before diagnosis compared to those with UC (48% versus 30%). The average distance for African American patients to the children’s hospital was 50.5 miles (± 55.9 miles) which was similar to the white patients (53.0 ± 59.8 miles). Of the 23 African American patients included in the study 14 (61%) had at least 2 visits before being diagnosed with IBD. In comparison, 15 of the 46 (33%) white patients had at least 2 visits before receiving a diagnosis of IBD. Most patients had a pediatrician listed as their primary care provider for both African American and white patients (70% versus 80%). CONCLUSION The significance of a delay in diagnosis and pediatric IBD is unclear, however further studies to determine if less access of care is predictive of greater disease severity and activity at presentation may be warranted. Additional studies will be completed to determine the relationship between proximity to bus stops and disease burden at diagnosis.

Louisiana Medicaid access for treatment and care for hepatitis C virus (LA-MATCH) project: A cross-sectional study protocol.

IntroductionThis article presents the Louisiana Hepatitis C Elimination Program’s evaluation protocol underway at the Louisiana State University Health Sciences Center–New Orleans. With the availability of direct-acting antiviral (DAA) agents, the elimination of Hepatitis C (HCV) has become a possibility. The HCV Elimination Program was initiated by the Louisiana Department of Health (LDH) Office of Public Health (OPH), LDH Bureau of Health Services Financing (Medicaid), and the Louisiana Department of Public Safety and Corrections (DPSC) to provide HCV treatment through an innovative pricing arrangement with Asegua Therapeutics, whereby a fixed cost is set for a supply of treatment over five years.Materials and methodsA cross-sectional study design will be used. Data will be gathered from two sources: 1) an online survey administered via REDCap to a sample of Medicaid members who are receiving HCV treatment, and 2) a de-identified data set that includes both Medicaid claims data and OPH surveillance data procured via a Data Use Agreement between LSUHSC-NO and Louisiana Medicaid.DiscussionThe evaluation will contribute to an understanding of the scope and reach of this innovative treatment model, and as a result, an understanding of areas for improvement. Further, this evaluation may provide insight for other states considering similar contracting mechanisms and programs.

Studies Detail Heart Risks for Firefighters

Studies Detail Heart Risks for Firefighters

Assessment of Video Capsule Endoscopy in the Management of Acute Gastrointestinal Bleeding During the COVID-19 Pandemic

Evaluation of acute gastrointestinal (GI) bleeding using invasive endoscopic procedures comprising the standard of care (SOC)-upper endoscopy and colonoscopy-can expose the endoscopy staff to SARS-CoV-2. Video capsule endoscopy (VCE) does not generate aerosols and only requires 1 person to manage the procedure. To examine the safety of VCE for the initial evaluation of GI bleeding at the peak of the COVID-19 pandemic to identify signs of active bleeding while minimizing patient and personnel exposure, saving personal protective equipment, and avoiding invasive or unnecessary procedures. A multicenter (UMass Memorial Medical Center and Louisiana State University Health Sciences Center) retrospective cohort study including 146 patients with COVID-19 who received VCE as the first-line diagnostic modality was conducted from March 15 to June 15, 2020, compared with SOC in January 2020 for evaluation of GI bleeding. The association between treatment and outcomes was estimated using multivariable regression adjusting for potential confounders. Propensity score matching was used to verify the results. The primary end point was detection of active bleeding or stigmata of recent bleeding. Secondary end points included the number of patients requiring any invasive procedures, number of additional procedures, rates of rebleeding and rehospitalization, transfusion requirements, and mortality. Among 146 patients, 92 (63.0%) were men; mean (SD) age was 64.93 (14.13) years in the COVID-19 group and 61.33 (13.39) years in the SOC group. Active bleeding or stigmata of recent bleeding was observed in 44 (59.5%) patients in the COVID-19 group compared with 18 (25.0%) in the SOC group (adjusted odds ratio, 5.23; 95% CI, 2.23 to 12.27). Only 36 patients (48.7%) in the COVID-19 group required any invasive procedure during the hospitalization compared with 70 (97.2%) in the SOC group (adjusted odds ratio, 0.01; 95% CI, 0.001 to 0.08). The mean (SD) number of invasive procedures was 0.59 (0.77) per patient in the COVID-19 group compared with 1.18 (0.48) per patient in the SOC group (adjusted difference, -0.54; 95% CI, -0.77 to -0.31). Both approaches appeared to be safe and there was no significant difference in transfusion requirements, rebleeding, rehospitalization, or in-hospital mortality. No mortality was attributed to GI bleeding in either group. In this cohort study, first-line diagnostic evaluation of acute GI bleeding using VCE appeared to be a safe and useful alternative to the traditional approach of upper endoscopy and colonoscopy. Use of VCE was associated with increased detection of active bleeding and a reduced number of invasive procedures and unnecessary exposure of personnel to SARS-CoV-2 and use of personal protective equipment.