State University Wexner Medical Center Research Articles

Clinical Outcomes with Ertapenem for Pneumonia in Obese versus Nonobese Patients.

The objective of this study was to compare the rate of pneumonia resolution in obese (body mass index [BMI], ≥30 kg/m2) and nonobese (BMI, <30 kg/m2) patients treated with 1 gram ertapenem daily. In this retrospective cohort study, we evaluated patients treated at The Ohio State University Wexner Medical Center between 1 January 2015 and 31 August 2020. Patients were included if they were between 18 and 89 years old and received ertapenem for at least 48 hours for pneumonia treatment. Patients were excluded if they were pregnant, were incarcerated, had renal impairment, received antibiotics with Gram-negative activity for a significant period prior to or in addition to ertapenem, and had other concomitant deep-seated infections. The primary outcome of clinical resolution was defined as meeting any of the following three criteria in order of evaluations: discontinuation of antibiotics by day 8 of therapy, afebrile while on ertapenem in addition to a decrease in white blood cell count, or improvement on chest radiograph at day 7 of therapy. A multivariable logistic regression analysis was performed to examine the association between obesity and clinical resolution, while adjusting for proven confounders. There were 76 nonobese and 65 obese patients included. The median patient BMI was 23.7 kg/m2 (21.0 to 26.9) and 35.0 kg/m2 (32.8 to 39.8) for the nonobese and obese cohorts, respectively. Clinical resolution was achieved in 78% (59/76) of nonobese and 75% (49/65) of obese patients (P = 0.75) without an observed difference in the regression model. Outcomes were similar in obese and nonobese patients treated with 1 gram of ertapenem daily for pneumonia.

Out-of-hospital cardiac arrest due to refractory pulseless ventricular tachycardia and/or ventricular fibrillation

Abstract Background Survival rates for out-of-hospital cardiac arrest (OOHCA) are extremely low and neurologic recovery is poor. Extracorporeal cardiopulmonary resuscitation (ECPR), which combines extracorporeal membrane oxygenation (ECMO) with cardiopulmonary resuscitation (CPR), has emerged as a viable strategy to improve outcomes in OOHCA. A collaborative ECPR program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire Emergency Medical Services (EMS). Purpose Outcomes for patients who present as an ECPR alert from the field, but did not meet predefined criteria for placement of extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL) is described. Methods Between September 15, 2017 and October 12, 2019, 50 subjects presented as an ECPR alert for OOHCA secondary to pulseless VT/VF refractory to defibrillation. All subjects were placed on an automated CPR device prior to transfer to the CCL. From these 50 individuals, 28 (56%) did not meet prespecified laboratory criteria (lactate ≤15 mg/dL, partial pressure of oxygen (PaO2) ≥50 mm Hg, end-tidal carbon dioxide (ETCO2) of ≥10) and did not have a shockable rhythm in the CCL, thus ECMO was not placed and usual care for cardiac arrest was administered. Results Nine (32%) of the 28 patients achieved return of spontaneous circulation (ROSC), while the remaining 19 (68%) where pronounced deceased in the CCL. All 9 patients who achieved ROSC underwent a coronary angiography with 4 (44%) requiring percutaneous coronary intervention and 4 (44%) requiring an acute mechanical circulatory support device (Impella with 1 change out to ECMO). Of the patients that achieved ROSC, 4 (44%) were discharged from the hospital with good neurologic recovery; the remaining 5 (56%) ultimately expired during the hospitalization. From the initial 28 patient cohort, there were 4 (14%) patients discharged alive. Patients who achieved ROSC as compared to no ROSC were found on presentation in the CCL to have a significantly lower lactate (12.3±4.3 vs 16.2±3.6, respectively; p=0.03) and greater PaO2 (145±125 vs 47±9, respectively; p=0.01); there was no significant differences between groups in ETCO2, age or emergency services dispatch to CCL arrival time. Conclusion This study demonstrates that an ECPR program for OOHCA due to refractory VT/VF may provide benefit to patients that do not meet the predefined criteria for ECMO. This may be due to minimizing no flow/low flow time by early recognition and ongoing CPR en route to the CCL by a skilled EMS team, high efficiency citywide expedited transport/triage, the provision of high quality uninterrupted chest compressions using the mechanical CPR device during transport, and the care provided by highly trained multidisciplinary team members in the CCL. Funding Acknowledgement Type of funding sources: None.

Reply by Authors.

No AccessUrology PracticeHealth Policy1 Jan 2022Reply by Authorsis a reply to letterEditorial Commentary Sarah Beebe, Alicia Scimeca, Dinah Diab, Nathan C. Wong, Tasha Posid, and Shawn Dason Sarah BeebeSarah Beebe Department of Urology, The Ohio State University, Columbus, Ohio Equal study contribution. More articles by this author , Alicia ScimecaAlicia Scimeca Department of Urology, The Ohio State University, Columbus, Ohio More articles by this author , Dinah DiabDinah Diab Department of Urology, The Ohio State University, Columbus, Ohio More articles by this author , Nathan C. WongNathan C. Wong Department of Urology, New York Medical College, Valhalla, New York More articles by this author , Tasha PosidTasha Posid †Correspondence: Department of Urology, The Ohio State University Wexner Medical Center, 915 Olentangy River Rd., Suite 3100, Columbus, Ohio 43212 telephone: 614-685-8665; FAX: 614-293-3565; E-mail Address: [email protected] Department of Urology, The Ohio State University, Columbus, Ohio Equal study contribution. More articles by this author , and Shawn DasonShawn Dason Department of Urology, The Ohio State University, Columbus, Ohio Equal study contribution. More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000267.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." Urology Practice, 9(1), p. 79 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology PracticeSep 30, 2021, 12:00:00 AMEditorial Commentary Volume 9Issue 1January 2022Page: 79-79 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Beebe Department of Urology, The Ohio State University, Columbus, Ohio Equal study contribution. More articles by this author Alicia Scimeca Department of Urology, The Ohio State University, Columbus, Ohio More articles by this author Dinah Diab Department of Urology, The Ohio State University, Columbus, Ohio More articles by this author Nathan C. Wong Department of Urology, New York Medical College, Valhalla, New York More articles by this author Tasha Posid Department of Urology, The Ohio State University, Columbus, Ohio †Correspondence: Department of Urology, The Ohio State University Wexner Medical Center, 915 Olentangy River Rd., Suite 3100, Columbus, Ohio 43212 telephone: 614-685-8665; FAX: 614-293-3565; E-mail Address: [email protected] Equal study contribution. More articles by this author Shawn Dason Department of Urology, The Ohio State University, Columbus, Ohio Equal study contribution. More articles by this author Expand All Advertisement PDF DownloadLoading ...

The impact of comorbidity identification on outcomes in patients with pyoderma gangrenosum: A retrospective cohort study of previously hospitalized patients

The impact of comorbidity identification on outcomes in patients with pyoderma gangrenosum: A retrospective cohort study of previously hospitalized patients

RyR2 Gain-of-Function and Not So Sudden Cardiac Death

RyR2 Gain-of-Function and Not So Sudden Cardiac Death

Transmission of COVID-19 on an Inpatient Hospital Prison Unit

Background: Prison populations have been disproportionally affected by COVID-19, partly due to challenges related to social distancing. Data on viral transmission dynamics in inpatient prison units remain limited. The Ohio State University Wexner Medical Center (OSUWMC) has a 24-bed inpatient prison unit in collaboration with the Ohio Department of Rehabilitations and Corrections (ODRC). The unit has 5 shared rooms holding 4 patients each and 4 single-patient rooms. Several cases of inpatient transmission of COVID-19 were identified on the inpatient prison unit. Methods: An IRB-approved retrospective chart review was conducted to evaluate inpatient transmission dynamics of hospital-acquired (HCA) COVID-19. All ODRC patients admitted from March 1 to April 24, 2020, were included. Patients assigned to the prison unit during their hospital stay were evaluated for potential HCA COVID-19, defined as a positive SARS-CoV-2 test ≥4 days after admission. Patient characteristics, testing data, symptoms, aerosol-generating procedures (AGPs), and room assignments were reviewed. Healthcare workers (HCWs) and correction officers (COs) working on the unit who tested positive during this period were identified. Results: In total, 142 ODRC patients were admitted during the study period and 89% had a positive SARS-CoV-2 testing prior to or during admission. Also, 61 patients (43%) were assigned to the prison unit. Moreover, 8 patients on the unit met potential HCA COVID-19 definition with 7 linked to 3 distinct clusters. Also, 7 COs had COVID-19 (outside hospital exposure) and 5 HCWs acquired COVID-19 from patient exposure on the unit. In cluster 1, 4 patients admitted to the same room developed HCA COVID-19. A symptomatic index patient not tested on admission given an atypical presentation required CPAP and frequent nebulizer treatments. In cluster 2, 1 patient from cluster 1 was transferred to another room. The new roommate subsequently developed HCA COVID-19. In cluster 3, a symptomatic correctional officer was assigned to 2 patients in a shared room; the patients later developed HCA COVID-19. Conclusions: Three patient clusters of HCA COVID-19 on a prison unit were identified. Aerosol transmission potentially played a role in cluster 1. Inpatient transmission within the unit prompted updated guidance for ODRC admissions, including universal SARS-CoV-2 admission testing, excluding patients requiring AGPs from shared rooms, and preemptive isolation for patients from an ODRC facility experiencing a COVID-19 surge. Universal testing was quickly expanded to all inpatient admissions. HCWs and COs were also linked to inpatient transmission, highlighting the importance of strict infection control practices for patient populations who cannot socially distance.Funding: NoDisclosures: None

A Cluster of Coronavirus Disease 2019 (COVID-19) Cases on an Inpatient Hospital Unit Involving Multiple Modes of Transmission

Background: The Ohio State University Wexner Medical Center identified a cluster of coronavirus disease 2019 (COVID-19) cases on an inpatient geriatric stroke care unit involving both patients and staff. The period of suspected severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission and exposure on the unit was December 20, 2020, to January 1, 2021, with some patients and staff developing symptoms and testing positive within the 14 days thereafter. Methods: An epidemiologic investigation was conducted via chart review, staff interviews, and contact tracing to identify potential patient and staff linkages. All staff who worked on the unit were offered testing regardless of the presence of symptoms as well as all patients admitted during the outbreak period. Results: In total, 6 patients likely acquired COVID-19 in the hospital (HCA). An additional 6 patients admitted to the unit during the outbreak period subsequently tested positive but had other possible exposures outside the hospital (Fig. 1). One patient failed to undergo COVID-19 testing on admission but tested positive early in the cluster and is suspected to have contributed to patient to employee transmission. Moreover, 32 employees who worked on the unit in some capacity during this period tested positive, many of whom became symptomatic during their shifts. In addition, 18 employees elected for asymptomatic testing with 3 testing positive; these were included in the total. Some staff also identified potential community exposures. Additionally, staff reported an employee who was working while symptomatic with inconsistent mask use (index employee) early in the outbreak period. The index employee likely contributed to employee transmission but had no direct patient contact. Our epidemiologic investigation ultimately identified 12 employees felt to be linked to transmission based on significant, direct patient care provided to the patients within the outbreak period (Fig. 1). In addition, 3 employees had an exposure outside the hospital indicating likely community transmission. Conclusions: Transmission was felt to be multidirectional and included employee-to-employee, employee-to-patient, and patient-to-employee transmission in the setting of widespread community transmission. Interventions to stop transmission included widespread staff testing, staff auditing regarding temperature and symptom monitoring, and re-education on infection prevention practices. Particular focus was placed on appropriate PPE use including masking and eye protection, hand hygiene, and cleaning and disinfection practices throughout the unit. SARS-CoV-2 admission testing and limited visitation remain important strategies to minimize transmission in the hospital.Funding: NoDisclosures: None

O32 Leveraging Every Door Direct Mail for Remote Recruitment of a Rural Study Sample: Response Rate and Representativeness

Background Travel restrictions imposed by the COVID-19 pandemic forced researchers to recruit remotely, further challenging the recruitment of “hard-to-reach” populations, such as rural communities. Every Door Direct Mail (EDDM) is a service of the USPS in which mail is sent to all ‘postal customers’ in a designated region. While relatively underexplored as a research tool, 1 study reported similar response rates to addressed survey mailings with lower cost and potentially lower demographic bias. Objective To evaluate the utility of EDDM as a tool for recruiting a representative sample of rural households in Appalachia Ohio. Study Design, Setting, Participants As part of a larger effort to evaluate community resource utilization in relation to diet, health and food security, a study recruitment postcard was sent via EDDM to all residential addresses (n = 31,201) within an 18 zip code region in Southeastern OH in June 2020. Adult residents were invited to complete a survey online via QR code or short link or to call for a mailed survey. Measurable Outcome/Analysis Respondent demographic characteristics were generated using SPSS and compared with the region's 2019 U.S. Census Bureau statistics. Results A total of 724 households completed the survey, reflecting a response rate lower than estimates for addressed mailings (2.3% vs 6%). Compared to census data, a greater proportion of respondents were female (68% vs 51%), and highly educated (60% vs 36% college graduates); a smaller proportion were non-Hispanic (90% vs 98%), White (88% vs 92%), had ≥1 child in the household (23% vs 28%), and a household income Conclusion EDDM was a viable method for remote recruitment of a rural sample. Further work is needed to explore its efficacy in recruiting representative samples, and studies to inform best practices for its use are warranted. Funding NIH, The Ohio State University's Initiative for Food and AgriCultural Transformation (InFACT), a Discovery Themes program (learn more at discovery.osu.edu/infact); Award Number UL1TR002733 National Center for Advancing Translational Sciences (#5591); and, the Clinical Research Center/Center for Clinical Research Management of The Ohio State University Wexner Medical Center and The Ohio State University College of Medicine in Columbus, Ohio. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences, the National Institutes of Health, or The Ohio State University.

Shingles Occurs in Only 0.5% of Myeloma Patients on Any Dose of Antiviral Prophylaxis

Background: CDC estimates that approximately 30% of persons in the U.S. will experience shingles during their lifetimes (http://www.cdc.gov/shingles/surveillance.html). The incidence among people 60 years of age and older is about 10 cases per 1,000 U.S. population annually. With a median age of 70 y.o. and frequent proteasome inhibitor use (Kim SJ et al, Clinical lymphoma & myeloma, 2008), multiple myeloma patients often receive scheduled prophylaxis for shingles with acyclovir or valacyclovir; however, there are currently no guidelines on the appropriate dosage for the prevention of shingles. Recent studies have used antiviral doses of acyclovir 2400mg/day to as low as acyclovir 200 mg/day to prevent shingles (Pour L et al., Clinical lymphoma & myeloma 2009; Kim SJ et al., Jpn J Clin Oncol 2011), but doses of 200-800 mg acyclovir per day are common in clinical practice. By reviewing all myeloma patients treated over the last 6 years, we hypothesized that a less than 1% failure rate can be achieved using the equivalent of acyclovir 400 mg twice daily in a patient with normal renal function. In addition, based on the findings of a recent study (Dosani T et al., Blood, 2017), which demonstrated that ALC/AMC ratio at time of multiple myeloma diagnosis can be used as an indicator of baseline immune status, we hypothesized in this present study that multiple myeloma patients who had shingles have a significantly lower ALC/AMC ratio on average than patients who did not have shingles.Methods: A retrospective chart review was conducted on 1,210 multiple myeloma patients treated at The Ohio State University Wexner Medical Center. In addition to demographic information on age, gender, age at multiple myeloma diagnosis, multiple myeloma stage and karyotype, and length of survival, information on the presence of shingles after the diagnosis of multiple myeloma, medication and dosage of prophylactic antivirals, and compliance to medication was also collected. For patients who developed shingles and were compliant with prescribed antiviral medication, their effective dose of antiviral was determined by dividing their dose of antiviral per day by their estimated GFR at the time of shingles diagnosis. Valacyclovir was converted to an equivalent dose of acyclovir (acyclovir 400 mg = valacyclovir 250 mg). GFR was determined by the CKD-EPI method, using serum creatinine and weight values taken near the time of shingles diagnosis. ALC/AMC ratios were estimated using ALC and AMC values taken near the time of multiple myeloma diagnosis. Patients with shingles were compared to an equal number of age- and gender-matched controls using a Wilcoxon rank-sum test, and patients with no ALC or AMC values taken near time of diagnosis were excluded from final comparison.Results: Demographic information on the patients included in this study can be found in Table 1. Out of 1210 multiple myeloma patients, 127 patients (10.5%) developed shingles after diagnosis, and of these, only 6 patients (0.5%) were both prescribed a prophylactic antiviral (acyclovir or valacyclovir) and were compliant with their antiviral medication (Figure 1). Most patients (77%) were not receiving antiviral prophylaxis, and even if antivirals were prescribed, only 21% were compliant. The average time from multiple myeloma diagnosis to shingles diagnosis was 1.7 years. For patients prescribed acyclovir prophylaxis, doses ranged 0-2400 mg/day, with most patients (62%) taking 800mg/day and 49% of patients taking 400mg/day (Table 2). Percentages do not add up to 100% since many patients had their doses changed over time. ALC/AMC ratios were not significantly different (p=0.78) between patients with shingles vs controls (Figure 2).Discussion: Shingles occurred in 10% of myeloma patients during the retrospective period. Only twenty percent of myeloma patients that suffered a shingles exacerbation were prescribed an antiviral, and, if they were prescribed an antiviral, only 6 of 127 (4.7%) patients who developed shingles were taking prophylactic antivirals as prescribed. Given a compliance rate of 20.7% among patients diagnosed with shingles, compliance more than dose should be emphasized in preventing shingles exacerbations. This highlights the value of patient education and compliance strategies to decrease patient morbidity in clinical practice (Bender BG, JAMA Pediatr, 2015). [Display omitted] DisclosuresHofmeister:Janssen: Research Funding; Thrassos: Honoraria, Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Research Funding; Takeda: Research Funding; Karyopharm: Research Funding; Bristol-Myers Squibb: Research Funding; Celgene: Research Funding.

B-Cell Lymphoma Patients Have a 10% Risk of Shingles, 7% in Cutaneous T-Cell Lymphoma

Background: Patients with lymphoma can be immunosuppressed from the disease, treatment or both. One indicator of cellular mediated immunity is reactivation of Varicella Zoster (VZV), a painful viral infection estimated to occur to 30% of U.S. population during a lifetime and associated with a particularly morbid post-herpetic neuralgia. Bortezomib and dexamethasone have been shown to be correlated with increased rates of varicella zoster and other viral infections (Kim SJ et al, Clinical lymphoma & myeloma, 2008). Autologous stem cell transplant depletes cellular- and humoral-immunity (Kamber C et al, BMT, 2015). While the main risk factor for VZV reactivation is age (Harpaz R, MMWR Recomm Rep, 2008), the underlying malignancy might play a large role in the risk of VZV reactivation. There is little data comparing the proportion of VZV in multiple myeloma (MM) with other indolent B and T-cell lymphomas. The purpose of this study is to compare varicella infection in MM patients with chronic lymphocytic leukemia (CLL), cutaneous T-cell lymphoma (CTCL), and follicular lymphoma (FL). Given that VZV is a relatively common infection in patients with MM, we hypothesized that varicella reactivation in MM patients occurs at a higher rate than in patients with CLL, CTCL, or FL.Methods: A retrospective chart review of 3,765 patients was conducted. Patients were eligible if they had been diagnosed with 1 of 4 malignancies - MM (1,210), CLL (2,520), CTCL (434), or FL (809). Patients diagnosed with other malignancies i.e. mantle cell lymphoma were excluded, as were patients with multiple malignancies i.e. MM and FL. All patients had been seen at the Ohio State University Wexner Medical Center during their treatment. For each patient, information on age, gender, length of survival, age at diagnosis of hematologic malignancy, and proportion of patients with shingles was collected. Only patients who were diagnosed with shingles after hematologic cancer diagnosis were included as positive. Associations between malignancy type and development of shingles were analyzed by a chi-square test, and logistic regression was used to calculate odds ratios for shingles between MM and the other malignancies, controlling for age as a possible confounder. Median survival time was calculated in years using the Kaplan-Meier method, calculated as the time from cancer diagnosis to date of last contact if alive, or date of death if deceased. Seven patients were excluded from survival analysis due to having the same date of diagnosis as date of last contact. This study was approved by the cancer institutional review board.Results: Patient demographic information is found in Table 1. Of the 1,210 MM patients, 127 developed shingles after diagnosis (10.5%); of 2520 CLL patients, 326 were positive (12.9%); of 434 CTCL patients, 33 were positive (7.6%); of 809 FL patients, 78 were positive (9.6%). At a significance level of a=0.05, there was a significant association between cancer type and shingles (χ2=15.59, df=3, p-value=0.0014). Odds ratios comparing MM to each of the other lymphomas were not found to be significant. The median survival time in years was 8.8 for MM, 20.7 for CLL, 25.1 for CTCL, and 24.6 for FL (Figure 1).Conclusion: Patients with MM had the lowest median survival (8.8 years), and a significant association between cancer type and shingle incidence was found, with CTCL patients having the lowest incidence of shingles (7.6%) within the retrospective period. However, the odds ratios comparing MM to the other 3 lymphomas was not significant, showing that the MM patients did not have significantly higher rates of shingles as originally hypothesized. These results demonstrate the differences in viral infection incidence and disease course between hematologic malignancies, and that antiviral strategies more specialized to T and B cell lymphomas may be important in reducing the risk of viral infection. [Display omitted] DisclosuresHofmeister:Celgene: Research Funding; Adaptive Biotechnologies: Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharm: Research Funding; Takeda: Research Funding; Thrassos: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Research Funding; Bristol-Myers Squibb: Research Funding; Roche: Research Funding.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Marijuana use and sleep quality during pregnancy

Objective Marijuana use among pregnant women is on the rise in part due to the perception that marijuana may improve problems related to pregnancy such as poor sleep. This study’s objective was to examine associations between marijuana use and sleep quality among a sample of women during pregnancy. Material and methods The sample included women seeking prenatal care at The Ohio State University Wexner Medical Center (2010–2015). Intake assessments included medical, demographic, and socioeconomic domains, as well as the Pittsburgh Sleep Quality Index. Marijuana use during pregnancy was determined using urine screens, chart abstraction, and self-report. Women completed standardized questionnaires regarding sleep quality, depressive symptoms, anxiety, stress, and discrimination at enrollment and each subsequent trimester. A linear mixed-effect model was used to assess the relationship between sleep variables and marijuana use adjusted for maternal race, education, household income, age, marital status, depressive symptoms, anxiety, stress, discrimination, and use of tobacco and other substances during pregnancy. Women completed the sleep quality assessments for a total of 294 pregnancies, which comprise the study population. Results Among the study sample (n = 294), 93 women used marijuana and 201 women did not use marijuana during their pregnancies. Women who used marijuana (n = 93) were more likely to identify as African-American (73% vs 58%; p = .01), report government health insurance (98% vs 89%; p = .001), use tobacco during pregnancy (66% vs 33%; p < .001), report less household income (70% vs 43% < 10,000 annual household income; p < .001), and be unmarried (69% vs 49%; p < .001) compared to women who did not. Mean sleep quality was similar among women who did (µ = 7.6; SD = 4.0) and did not use marijuana during pregnancy (µ = 7.7; SD = 4.0), and both groups had a mean score worse than the conventional cutoff for poor sleep quality (>5). In fact, both groups reported worse sleep than is typically observed among cohorts reporting poor sleep, which have ranged from 5.3 to 6.3. Conclusions Current findings did not suggest differences in sleep quality between women who used and did not use marijuana during pregnancy. Findings are contrary to the perception that marijuana use alleviates sleep-related problems during pregnancy. Given well-documented adverse outcomes associated with prenatal marijuana exposure for children and the increase in women using marijuana during pregnancy, providers should be prepared to discuss possible harms associated with marijuana use during pregnancy as well as provide psychoeducational information and service referrals to those interested. Future studies could improve upon this design by assessing objective measures of sleep, such as actigraphy, as well as marijuana use repeatedly throughout pregnancy, which may be a more optimal strategy for illuminating potential relationships between marijuana use and sleep during pregnancy.

Deep-Learning–Driven Quantification of Interstitial Fibrosis in Digitized Kidney Biopsies

Interstitial fibrosis and tubular atrophy (IFTA) on a renal biopsy are strong indicators of disease chronicity and prognosis. Techniques that are typically used for IFTA grading remain manual, leading to variability among pathologists. Accurate IFTA estimation using computational techniques can reduce this variability and provide quantitative assessment. Using trichrome-stained whole-slide images (WSIs) processed from human renal biopsies, we developed a deep-learning framework that captured finer pathologic structures at high resolution and overall context at the WSI level to predict IFTA grade. WSIs (n=67) were obtained from The Ohio State University Wexner Medical Center. Five nephropathologists independently reviewed them and provided fibrosis scores that were converted to IFTA grades: ≤10% (none or minimal), 11% to 25% (mild), 26% to 50% (moderate), and >50% (severe). The model was developed by associating the WSIs with the IFTA grade determined by majority voting (reference estimate). Model performance was evaluated on WSIs (n=28) obtained from the Kidney Precision Medicine Project. There was good agreement on the IFTA grading between the pathologists and the reference estimate (κ=0.622±0.071). The accuracy of the deep-learning model was 71.8%±5.3% on The Ohio State University Wexner Medical Center and 65.0%±4.2% on Kidney Precision Medicine Project data sets. Our approach to analyzing microscopic- and WSI-level changes in renal biopsies attempts to mimic the pathologist and provides a regional and contextual estimation of IFTA. Such methods can assist clinicopathologic diagnosis.

A Pilot Randomized Trial of Transdermal Nicotine for Pulmonary Sarcoidosis

Tobacco smoking is associated with a reduced risk of developing sarcoidosis, and we previously reported that nicotine normalizes immune responses to environmental antigens in patients with active pulmonary sarcoidosis. The effects of nicotine on the progression of pulmonary sarcoidosis are unknown. Is nicotine treatment well tolerated, and will it improve lung function in patients with active pulmonary sarcoidosis? With local institutional review board approval, a randomized, double-blind, controlled pilot trial was conducted of daily nicotine transdermal patch treatment (21mg daily) or placebo patch use for 24weeks. The Ohio State University Wexner Medical Center and Cleveland Clinic enrolled 50 consecutive subjects aged≥ 18 years with active pulmonary sarcoidosis, based on symptoms (ie, dyspnea, cough) and objective radiographic evidence of infiltrates consistent with nonfibrotic lung disease. Each study group was compared at 26weeks based on repeated measures of FVC, FEV1, quantitative lung texture score based on CT texture analysis, Fatigue Assessment Score (FAS), St. George's Respiratory Questionnaire (SGRQ), and the Sarcoidosis Assessment Tool. Nicotine treatment was associated with a clinically significant, approximately 2.1%(70mL) improvement in FVC from baseline to 26weeks. FVC decreased by a similar amount (2.2%) in the placebo group, with a net increase of 140mL (95%CI, 10-260) when comparing nicotine vsplacebo groups at 26weeks. FEV1 and FAS improved marginally in the nicotine-treated group, compared with those on placebo. No improvement was observed in lung texture score, FAS, St. George's Respiratory Questionnaire score, or the Sarcoidosis Assessment Tool. There were no reported serious adverse events or evidence of nicotine addiction. Nicotine treatment was well tolerated in patients with active pulmonary sarcoidosis, and the preliminary findings of this pilot study suggest that it may reduce disease progression, based on FVC. ClinicalTrials.gov; No.: NCT02265874; URL: www.clinicaltrials.gov.

Estrogen Receptor Is Expressed in Uveal Melanoma: A Potential Target for Therapy

Background: Metastatic uveal melanoma (UM) has no effective treatment. To date, no publications have reported immunohistochemical evidence of estrogen receptors (ERs) in UM; however, changes in pathologic reporting for ER in breast carcinoma prompted a re-examination of ER in UM, as it could represent a potential therapeutic target. Objective: To determine if UM tumors express ER by immunohistochemistry (IHC) using current methodology for breast cancer and to evaluate ER gene expression using a publicly available UM database. Methods: A retrospective IHC analysis with clinical correlation was performed on 2 cohorts: 57 cases from the Cleveland Clinic (CC) and 50 from the Ohio State University Wexner Medical Center (OSUWMC). Analysis of The Cancer Genome Atlas Project (TCGA) UM Dataset of 80 patients was also performed. Results: Presence of ER was detected by IHC in 20 of 34 (59%) analyzable cases in the CC cohort. Of the 50 patients in the OSU cohort, 52 specimens from 47 patients were sufficient for analysis. Of these 47 cases, 29 (62%) had tumor that was ER positive in ≥1% nuclei. In the second cohort, positivity was classified as positive (≥10% nuclei, 34% cases) or low positive (1–9% nuclei, 28% cases). In 5 patients, there were paired samples, that is, primary tumor and subsequent recurrence or metastasis, with concordance for ER in 4 of 5 cases. In the TCGA database, elevated ESR1 and ESR2 gene expression was identified in a subset of UM tumors with poor genetic prognostic features. Conclusions and Relevance: Potentially actionable ER expression is present in greater than half of UM cases by IHC. Gene expression of ESR1 and ESR2 was elevated in a subset of UM tumors with poor prognostic features. These data provide a rationale to evaluate ER as a potential target for therapy in UM.

220 A retrospective study of acute graft-versus-host disease and its mimickers in the post-transplant period

Acute Graft-versus-Host Disease (GVHD) is a potentially fatal immune response that requires differentiation from other hypersensitivity responses occurring after allogeneic stem cell transplantation. Our study retrospectively investigates a wide array of variables in 69 patients that underwent an allogenic stem cell transplant and were discharged with a GVHD or rash-related ICD9 code within 100 days between 2012-2014 at The Ohio State University Wexner Medical Center. When compared to non-GVHD rashes, GVHD had 7.4 times the odds to occur between days 20-40 than in 0-20 (p=0.004). GVHD was also associated with a higher body surface area affected (43.3% in GVHD vs. 29.7% in non-GVHD, p=0.031). When including any organ GVHD diagnosis, the rash was 9.2 times the odds to occur between days 20-40 (p=0.001). Furthermore, patients diagnosed with acute GVHD had 4.4 times the odds to experience diarrhea (p=0.032). While GVHD still poses a diagnostic challenge, this study reinforces the extreme importance of the timeline for the eruption to occur in comparison with other demographic and clinical factors and also introduces the potential value in the extent of involvement. Further studies should be conducted to increase the power of these findings as well as investigate further relationships regarding minor morphologic differences, body sites, and coexisting symptoms by only the most high-risk time period after transplant.

Increasing Resident Support Following Patient Suicide: Assessing Resident Perceptions of a Longitudinal, Multimodal Patient Suicide Curriculum.

ObjectivePatient suicide is a common experience in psychiatry residency, and its effects on trainees can be profound. There are currently no ACGME Common Program Requirements for education about patient suicide, and a need exists for evidence-based curricula to prepare residents for this difficult outcome.MethodsA comprehensive patient suicide curriculum was developed utilizing multiple modes of delivering content, including a training designed to foster built-in support among peers in the healthcare workplace. The content was delivered at intervals over the course of the 2019–2020 academic year for 43 psychiatry residents at The Ohio State University Wexner Medical Center. Pre- and post-curriculum surveys were obtained to assess the resident experience of the new curriculum.ResultsTwenty-seven residents completed the pre-curriculum survey and 25 completed the post-curriculum survey. Results demonstrated statistically significant improvements in ratings of preparedness to deal with the loss of a patient by suicide, preparedness to support a co-resident who has experienced the death of a patient by suicide, program-level support for residents, understanding systems-level and quality processes, and knowledge of what steps to take if finding out a patient has completed suicide.ConclusionsA multimodal approach incorporating understanding emotional reactions, provision of support, delineation of procedural issues, and education regarding quality and risk management considerations was effective at improving resident preparedness to cope following a patient suicide.

Evaluation of Red Blood Cell Transfusion Practice and Knowledge Among Cancer Surgeons

BackgroundTransfusion of blood products has a negative impact on surgical and cancer outcomes. The objective of the current study was to evaluate surgeons’ practice and knowledge of red blood cell transfusion for surgical patients. MethodsA survey of residents, fellows, and faculty surgeons at the Ohio State University Wexner Medical Center and surgeons who identified as taking care of cancer patients nationally was conducted. Four domains were addressed including perceived preoperative assessment and management of anemia, perceived use of transfusion alternatives, perceived use of and factors influencing packed red blood cell administration, and transfusion practice knowledge. ResultsAmong 158 respondents, 87 (64.5%) were surgeons on faculty at an academic medical center, 26 (19%) were surgeons in private practice, and 24 (15.2%) were surgical residents or fellows. The majority of respondents were surgical oncologists or hepatobiliary surgeons (N = 83, 62.0%) and had been in practice > 10 years (> 10–15 N = 28, 20.6%) and > 15 years N = 59, 43.4%). Only thirteen (N = 13, 8.2%) surgeons reported that they routinely complete a preoperative anemia workup. The majority of providers reported that they rarely or never use alternatives to transfusion such as erythropoietin (N = 135, 91.8%), tranexamic acid (N = 140, 94.6%), autologous blood transfusion (N = 141, 95.3%), or cell saver for benign (N = 107, 72.3%) or malignant cases (N = 133, 90.4%). Provider transfusion knowledge was variable. ConclusionsSurgeons varied widely in their transfusion practice and knowledge. Further education of surgeons regarding transfusion medicine and practice, as well as use of transfusion alternatives, could lead to improved patient outcomes. Patient blood management programs may help inform individual surgeon practices.

Mask Up: Academic-Community-Government Partnerships to Advance Public Health During COVID-19.

Mask Up: Academic-Community-Government Partnerships to Advance Public Health During COVID-19.

Prognostic implications of epidermal and platelet-derived growth factor receptor alterations in 2 cohorts of IDHwt glioblastoma.

BackgroundGlioblastoma remains a deadly brain cancer with dismal prognosis. Genetic alterations, including IDH mutations, 1p19q co-deletion status and MGMT promoter methylation have been proven to be prognostic and predictive to response to treatment in gliomas. In this manuscript, we aimed to correlate other mutations and genetic alterations with various clinical endpoints in patients with IDH-wild-type (IDHwt) glioblastoma.MethodsWe compiled a comprehensive clinically annotated database of IDHwt GBM patients treated at the Ohio State University Wexner Medical Center for whom we had mutational data through a CLIA-certified genomic laboratory. We then added data that is publicly available from Memorial Sloan Kettering Cancer Center through cBioPortal. Each of the genetic alterations (mutations, deletions, and amplifications) served as a variable in univariate and multivariate Cox proportional hazard models.ResultsA total of 175 IDHwt GBM patients with available MGMT promoter methylation data from both cohorts were included in the analysis. As expected, MGMT promoter methylation was significantly associated with improved overall survival (OS). Median OS for MGMT promoter methylated and unmethylated GBM was 26.5 and 18 months, respectively (HR 0.45; P = .003). Moreover, EGFR/ERBB alterations were associated with favorable outcome (HR of 0.37 (P = .003), but only in MGMT promoter unmethylated GBM. We further found that patients with EGFR/ERBB alterations who also harbored PDGFRA amplification had a significantly worse outcome (HR 7.89; P = .025).ConclusionsOur data provide further insight into the impact of genetic alterations on various clinical outcomes in IDHwt GBM in 2 cohorts of patients with detailed clinical information and inspire new therapeutic strategies for IDHwt GBM.