Now showing items 1-20 of 6122

    • An analytical model of population level chronic conditions and COVID-19 related hospitalization in the United States

      Datta, Biplab K.; Ansa, Benjamin E.; George, Varghese; Augusta University (BMC - Springer Nature, 2022-12)
      Background: The surge in the COVID-19 related hospitalization has been straining the US health system. COVID-19 patients with underlying chronic conditions have a disproportionately higher risk of hospitalization and intensive care unit (ICU) admission. We developed a retrospective analytical model of COVID-19 related hospitalizations and ICU admissions linked to each of the three major chronic conditions – hypertension, diabetes, and cardiovascular diseases (CVD). Methods: Based on the differential probability of hospitalization of the COVID-19 patients with and without a chronic condition, we estimate a baseline cumulative hospitalization rate and ICU admission rate using the population level chronic condition prevalence from the 2019 Behavioral Risk Factor Surveillance System survey. Next, we estimate the hospitalization and ICU admission rates under an alternative scenario of a lower prevalence of the same chronic condition, aligned with the World Health Organization target of 25% relative reduction of prevalence by 2025. We then compare the outcomes of the baseline and the alternative scenarios. Results: We estimate that the lower prevalence of hypertension would have lowered the cumulative hospitalization and ICU admission rates by more than 2.5%. The lower prevalence of diabetes and CVD would lower the cumulative hospitalization rate by 0.6% and 1.4% respectively. The decrease in the rates would have been relatively higher among Black and elderly (age 55+). Conclusions: Our model, thus, provides evidence on the importance of prevention, control, and management of chronic conditions to lessen the overwhelming financial and public health burden on the health system during a pandemic like the COVID-19.
    • Age-dependent regulation of SARS-CoV-2 cell entry genes and cell death programs correlates with COVID-19 severity

      Inde, Zintis; Croker, Ben A.; Yapp, Clarence; Joshi, Gaurav N.; Spetz, Johan; Fraser, Cameron; Qin, Xingping; Deskin, Brian; Ghelfi, Elisa; Webb, Gabrielle; et al. (American Assocation for the Advancement of Science, 2021-08)
      Novel coronavirus disease 2019 (COVID-19) severity is highly variable, with pediatric patients typically experiencing less severe infection than adults and especially the elderly. The basis for this difference is unclear. We find that mRNA and protein expression of angiotensin-converting enzyme 2 (ACE2), the cell entry receptor for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19, increases with advancing age in distal lung epithelial cells. However, in humans, ACE2 expression exhibits high levels of intra- and interindividual heterogeneity. Further, cells infected with SARS-CoV-2 experience endoplasmic reticulum stress, triggering an unfolded protein response and caspase-mediated apoptosis, a natural host defense system that halts virion production. Apoptosis of infected cells can be selectively induced by treatment with apoptosis-modulating BH3 mimetic drugs. Notably, epithelial cells within young lungs and airways are more primed to undergo apoptosis than those in adults, which may naturally hinder virion production and support milder COVID-19 severity.
    • Acute STEMI During the COVID-19 Pandemic at a Regional Hospital: Incidence, Clinical Characteristics, and Outcomes

      Ali, Syed H.; Hyder, Syed; Davis, Kathryn; Murrow, Jonathan R.; Augusta University (MD Edge, 2022-03)
      Objectives: The aim of this study was to describe the characteristics and in-hospital outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) during the early COVID-19 pandemic at Piedmont Athens Regional (PAR), a 330-bed tertiary referral center in Northeast Georgia. Methods: A retrospective study was conducted at PAR to evaluate patients with acute STEMI admitted over an 8-week period during the initial COVID-19 outbreak. This study group was compared to patients admitted during the corresponding period in 2019. The primary endpoint of this study was defined as a composite of sustained ventricular arrhythmia, congestive heart failure (CHF) with pulmonary congestion, and/or in-hospital mortality. Results: This study cohort was composed of 64 patients with acute STEMI; 30 patients (46.9%) were hospitalized during the COVID-19 pandemic. Patients with STEMI in both the COVID-19 and control groups had similar comorbidities, Killip classification score, and clinical presentations. The median (interquartile range) time from symptom onset to reperfusion (total ischemic time) increased from 99.5 minutes (84.8-132) in 2019 to 149 minutes (96.3-231.8; P= .032) in 2020. Hospitalization during the COVID-19 period was associated with an increased risk for combined in-hospital outcome (odds ratio, 3.96; P= .046). Conclusion: Patients with STEMI admitted during the first wave of the COVID-19 outbreak experienced longer total ischemic time and increased risk for combined in-hospital outcomes compared to patients admitted during the corresponding period in 2019.
    • Activation of a novel α2AAR-spinophilin-cofilin axis determines the effect of α2 adrenergic drugs on fear memory reconsolidation

      Saggu, Shalini; Chen, Yunjia; Cottingham, Christopher; Rehman, Hasibur; Wang, Hongxia; Zhang, Sixue; Augelli-Szafran, Corinne; Lu, Sumin; Lambert, Nevin; Jiao, Kai; et al. (Springer Nature, 2023-02)
      Posttraumatic stress disorder (PTSD) after the pandemic has emerged as a major neuropsychiatric component of post-acute COVID-19 syndrome, yet the current pharmacotherapy for PTSD is limited. The use of adrenergic drugs to treat PTSD has been suggested; however, it is hindered by conflicting clinical results and a lack of mechanistic understanding of drug actions. Our studies, using both genetically modified mice and human induced pluripotent stem cell-derived neurons, reveal a novel α2A adrenergic receptor (α2AAR)-spinophilin-cofilin axis in the hippocampus that is critical for regulation of contextual fear memory reconsolidation. In addition, we have found that two α2 ligands, clonidine and guanfacine, exhibit differential abilities in activating this signaling axis to disrupt fear memory reconsolidation. Stimulation of α2AAR with clonidine, but not guanfacine, promotes the interaction of the actin binding protein cofilin with the receptor and with the dendritic spine scaffolding protein spinophilin to induce cofilin activation at the synapse. Spinophilin-dependent regulation of cofilin is required for clonidine-induced disruption of contextual fear memory reconsolidation. Our results inform the interpretation of differential clinical observations of these two drugs on PTSD and suggest that clonidine could provide immediate treatment for PTSD symptoms related to the current pandemic. Furthermore, our study indicates that modulation of dendritic spine morphology may represent an effective strategy for the development of new pharmacotherapies for PTSD.
    • A review of audiovisual telemedicine utilization and satisfaction assessment during the COVID-19 pandemic

      Agbali, Raphael; Balas, Andrew E.; Beltrame, Francesco; De Leo, Gianluca; Augusta University (Cambridge University Press, 2022-12-20)
      Introduction The use of telemedicine has broadened as technology that both restores continuity of care during disruptions in healthcare delivery and routinely provides primary care alone or in combination with in-person care. During the Covid-19 outbreak, the use of telemedicine as a routine care modality further accelerated. Methods A review of scientific studies that used telemedicine to provide care from December 2019 to December 2020 is presented. From an initial set of 2,191 articles, 36 studies are analyzed. Evidence is organized and evaluated according to the country of study, the clinical specialty, the technology platform used, and satisfaction and utilization outcomes. Results Thirty-one studies reported high patient satisfaction scores. Eight studies reported satisfaction from both providers and patients with no uniformly accepted assessment instrument. Eight studies conducted a descriptive analysis of telemedicine use and patient adoption patterns. Less than one-third of studies were controlled before/after studies. Most studies were conducted in the USA followed by Europe. Conclusions Reported satisfaction rates are high, consistent with previously documented research, whereas utilization rates increased significantly compared with the prepandemic period. Future work in developing standardized uniform assessment instruments, embedded with each telemedicine system, would increase versatility and agility in the assessment, boosting statistical power and the interpretation of results.
    • A potential role for cannabichromene in modulating TRP channels during acute respiratory distress syndrome

      Khodadadi, Hesam; Salles, Évila Lopes; Shin, Eunice; Jarrahi, Abbas; Costigliola, Vincenzo; Kumar, Pritesh; Yu, Jack C.; Morgan, John C.; Hess, David C.; Vaibhav, Kumar; et al. (BMC - Springer Nature, 2021-12)
      Background: Acute respiratory distress syndrome (ARDS) is a life-threatening clinical syndrome whose potential to become one of the most grievous challenges of the healthcare system evidenced by the COVID-19 pandemic. Considering the lack of target-specific treatment for ARDS, it is absolutely exigent to have an effective therapeutic modality to reduce hospitalization and mortality rate as well as to improve quality of life and outcomes for ARDS patients. ARDS is a systemic inflammatory disease starting with the pulmonary system and involves all other organs in a morbid bidirectional fashion. Mounting evidence including our findings supporting the notion that cannabinoids have potential to be targeted as regulatory therapeutic modalities in the treatment of inflammatory diseases. Therefore, it is plausible to test their capabilities as alternative therapies in the treatment of ARDS. In this study, we investigated the potential protective effects of cannabichromene (CBC) in an experimental model of ARDS. Methods: We used, for the first time, an inhalant CBC treatment as a potential therapeutic target in a murine model of ARDS-like symptoms. ARDS was induced by intranasal administration of Poly(I:C), a synthetic mismatched double-stranded RNA, into the C57BL/6 mice (6–10 male mice/group, including sham, placebo, and CBC treated), three once-daily doses followed by a daily dose of inhalant CBC or placebo for the period of 8 days starting the first dose 2 h after the second Poly(I:C) treatment. We employed histologic, immunohistochemistry, and flow cytometry methods to assess the findings. Statistical analysis was performed by using one way analysis of variance (ANOVA) followed by Newman–Keuls post hoc test to determine the differences among the means of all experimental groups and to establish significance (p < 0.05) among all groups. Results: Our data showed that CBC was able to reverse the hypoxia (increasing blood O2 saturation by 8%), ameliorate the symptoms of ARDS (reducing the pro-inflammatory cytokines by 50% in lung and blood), and protect the lung tissues from further destruction. Further analysis showed that CBC may wield its protective effects through transient receptor potential (TRP) cation channels, TRPA1 and TRPV1, increasing their expression by 5-folds in lung tissues compared to sham and untreated mice, re-establishing the homeostasis and immune balance. Conclusion: Our findings suggest that inhalant CBC may be an effective alternative therapeutic target in the treatment of ARDS. In addition, Increased expression of TRPs cation channels after CBC treatment proposes a novel role for TRPs (TRPA1 and TRPV2) as new potential mechanism to interpret the beneficial effects of CBC as well as other cannabinoids in the treatment of ARDS as well as other inflammatory diseases. Importantly, delivering CBC through an inhaler device is a translational model supporting the feasibility of trial with human subjects, authorizing further research.
    • A Multicenter Evaluation of the Seraph 100 Microbind Affinity Blood Filter for the Treatment of Severe COVID-19

      Chitty, Stephen A.; Mobbs, Sarah; Rifkin, Brian S.; Stogner, Steven W.; Lewis, Michael S.; Betancourt, Jaime; Dellavolpe, Jeffrey; Abouzahr, Fadi; Wilhelm, Andrew M.; Szerlip, Harold M.; et al. (Wolters Kluwer, 2022-03-25)
      OBJECTIVES: The Seraph100 Microbind Affinity Blood Filter (Seraph 100) (ExThera Medical, Martinez, CA) is an extracorporeal therapy that can remove pathogens from blood, including severe acute respiratory syndrome coronavirus 2. The aim of this study was to evaluate safety and efficacy of Seraph 100 treatment for COVID-19. DESIGN: Retrospective cohort study. SETTING: Nine participating ICUs. PATIENTS: COVID-19 patients treated with Seraph 100 (n = 53) and control patients matched by study site (n = 53). INTERVENTION: Treatment with Seraph 100. MEASUREMENTS AND MAIN RESULTS: At baseline, there were no differences between the groups in terms of sex, race/ethnicity, body mass index, and need for mechanical ventilation. However, patients in the Seraph 100 group were younger (median age, 54 yr; interquartile range [IQR], 41-65) compared with controls (median age, 64 yr; IQR, 56-69; p = 0.009). Charlson comorbidity index scores were lower in the Seraph 100 group (2; IQR, 0-3) compared with the control group (3; IQR, 2-4; p = 0.006). Acute Physiology and Chronic Health Evaluation II scores were also lower in Seraph 100 subjects (12; IQR, 9-17) compared with controls (16; IQR, 12-21; p = 0.011). The Seraph 100 group had higher vasopressor-free days with an incidence rate ratio of 1.30 on univariate analysis. This difference was not significant after adjustment. Seraph 100-treated subjects were less likely to die compared with controls (32.1% vs 64.2%; p = 0.001), a difference that remained significant after adjustment. However, no difference in mortality was observed in a post hoc analysis utilizing an external control group. In the full cohort of 86 treated patients, there were 177 total treatments, in which only three serious adverse events were recorded. CONCLUSIONS: Although this study did not demonstrate consistently significant clinical benefit across all endpoints and comparisons, the findings suggest that broad spectrum, pathogen agnostic, blood purification can be safely deployed to meet new pathogen threats while awaiting targeted therapies and vaccines.
    • A County-Level Analysis of Socioeconomic and Clinical Predictors of COVID-19 Incidence and Case-Fatality Rates in Georgia, March–September 2020

      Berman, Adam E.; Miller, D. Douglas; Rahn, Daniel W.; Hess, David C.; Thompson, Mark A.; Mossialos, Elias A.; Waller, Jennifer L.; Augusta University (Sage Journals, 2021-09)
      Objectives: The global COVID-19 pandemic has affected various populations differently. We investigated the relationship between socioeconomic determinants of health obtained from the Robert Wood Johnson Foundation County Health Rankings and COVID-19 incidence and mortality at the county level in Georgia. Methods: We analyzed data on COVID-19 incidence and case-fatality rates (CFRs) from the Georgia Department of Public Health from March 1 through August 31, 2020. We used repeated measures generalized linear mixed models to determine differences over time in Georgia counties among quartile health rankings of health outcomes, health behaviors, clinical care, social and economic factors, and physical environment. Results: COVID-19 incidence per 100 000 population increased across all quartile county groups for all health rankings (range, 23.1-51.6 in May to 688.4-1062.0 in August). COVID-19 CFRs per 100 000 population peaked in April and May (range, 3312-6835) for all health rankings, declined in June and July (range, 827-5202), and increased again in August (range, 1877-3310). Peak CFRs occurred later in counties with low health rankings for health behavior and clinical care and in counties with high health rankings for social and economic factors and physical environment. All interactions between the health ranking quartile variables and month were significant (P <.001). County-level Gini indices were associated with significantly higher rates of COVID-19 incidence (P <.001) but not CFRs. Conclusions: From March through August 2020, COVID-19 incidence rose in Georgia’s counties independent of health rankings categorization. Differences in time to peak CFRs differed at the county level based upon key health rankings. Public health interventions should incorporate unique strategies to improve COVID-19–related patient outcomes in these environments.
    • A Comprehensive Biological and Synthetic Perspective on 2-Deoxy-d-Glucose (2-DG), A Sweet Molecule with Therapeutic and Diagnostic Potentials

      Wijayasinghe, Yasanandana S.; Bhansali, Meenakshi P.; Borkar, Maheshkumar R.; Chaturbhuj, Ganesh U.; Muntean, Brian S.; Viola, Ronald E.; Bhansali, Pravin R.; Augusta University (ACS Publications, 2022-03-10)
      Glucose, the primary substrate for ATP synthesis, is catabolized during glycolysis to generate ATP and precursors for the synthesis of other vital biomolecules. Opportunistic viruses and cancer cells often hijack this metabolic machinery to obtain energy and components needed for their replication and proliferation. One way to halt such energy-dependent processes is by interfering with the glycolytic pathway. 2-Deoxy-d-glucose (2-DG) is a synthetic glucose analogue that can inhibit key enzymes in the glycolytic pathway. The efficacy of 2-DG has been reported across an array of diseases and disorders, thereby demonstrating its broad therapeutic potential. Recent approval of 2-DG in India as a therapeutic approach for the management of the COVID-19 pandemic has brought renewed attention to this molecule. The purpose of this perspective is to present updated therapeutic avenues as well as a variety of chemical synthetic strategies for this medically useful sugar derivative, 2-DG.
    • A clinician perspective on the treatment of chronic myeloid leukemia in the chronic phase

      García-Gutiérrez, Valentin; Breccia, Massimo; Jabbour, Elias; Mauro, Michael; Cortes, Jorge E.; Augusta University (2022-12)
      Tyrosine kinase inhibitors (TKIs) have vastly improved long-term outcomes for patients with chronic myeloid leukemia (CML). After imatinib (a first-generation TKI), second- and third-generation TKIs were developed. With five TKIs (imatinib, dasatinib, bosutinib, nilotinib, and ponatinib) targeting BCR::ABL approved in most countries, and with the recent approval of asciminib in the USA, treatment decisions are complex and require assessment of patient-specific factors. Optimal treatment strategies for CML continue to evolve, with an increased focus on achieving deep molecular responses. Using clinically relevant case studies developed by the authors of this review, we discuss three major scenarios from the perspective of international experts. Firstly, this review explores patient-specific characteristics that affect decision-making between first- and second-generation TKIs upon initial diagnosis of CML, including patient comorbidities. Secondly, a thorough assessment of therapeutic options in the event of first-line treatment failure (as defined by National Comprehensive Cancer Network and European LeukemiaNet guidelines) is discussed along with real-world considerations for monitoring optimal responses to TKI therapy. Thirdly, this review illustrates the considerations and importance of achieving treatment-free remission as a treatment goal. Due to the timing of the writing, this review addresses global challenges commonly faced by hematologists treating patients with CML during the COVID-19 pandemic. Lastly, as new treatment approaches continue to be explored in CML, this review also discusses the advent of newer therapies such as asciminib. This article may be a useful reference for physicians treating patients with CML with second-generation TKIs and, as it is focused on the physicians’ international and personal experiences, may give insight into alternative approaches not previously considered.
    • A Care Step Pathway for the Diagnosis and Treatment of COVID-19–Associated Invasive Fungal Infections in the Intensive Care Unit

      Jones, Carolynn T.; Kopf, R. Scott; Tushla, Lisa; Tran, Sarah; Hamilton, Caroline; Lyman, Meghan; McMullen, Rachel; Shah, Drashti; Stroman, Angela; Wilkinson, Eryn; et al. (American Association of Critical-Care Nurses, 2022-12-01)
      Background In March 2020, the World Health Organization declared COVID-19, caused by the SARS-CoV-2 virus, a pandemic. Patients with severe cases resulting in hospitalization and mechanical ventilation are at risk for COVID-19–associated pulmonary aspergillosis, an invasive fungal infection, and should be screened for aspergillosis if they have persistent hemodynamic instability and fever. Early detection and treatment of this fungal infection can significantly reduce morbidity and mortality in this population. Objective To develop an evidence-based care step pathway tool to help intensive care unit clinicians assess, diagnose, and treat COVID-19–associated pulmonary aspergillosis. Methods A panel of 18 infectious disease experts, advanced practice registered nurses, pharmacists, and clinical researchers convened in a series of meetings to develop the Care Step Pathway tool, which was modeled on a tool developed by advanced practice nurses to evaluate and manage side effects of therapies for melanoma. The Care Step Pathway tool addresses various aspects of disease management, including assessment, screening, diagnosis, antifungal treatment, pharmacological considerations, and exclusion of other invasive fungal coinfections. Results The Care Step Pathway tool was applied in the care of a patient with COVID-19–associated aspergillosis. The patient was successfully treated. Conclusion The Care Step Pathway is an effective educational tool to help intensive care unit clinicians consider fungal infection when caring for COVID-19 patients receiving mechanical ventilation in the intensive care unit, especially when the clinical course is deteriorating and antibiotics are ineffective.
    • A 3-year analysis of the impact of COVID-19 pandemic on NSTEMI incidence, clinical characteristics, management, and outcomes

      Hyder, Syed A.; Schoenl, Samantha A.; Kesiena, Onoriode; Ali, Syed H.; Davis, Kathryn; Murrow, Jonathan R.; Augusta University (Wiley, 2023-02-01)
      Objective: The COVID-19 pandemic has been associated with decreased incidence of acute coronary syndrome with worsened outcomes. Few studies have addressed the effects beyond the initial phases of the pandemic. This study elucidated the incidence, clinical characteristics, management, and outcomes of NSTEMI at a tertiary referral center from sample time periods of 2019–2022. Methods: This study included consecutive NSTEMI patients from March 14–May 9, 2019–2022. Variables included baseline characteristics, clinical features on arrival, management strategy, time parameters, and adverse outcomes. The primary outcome was defined as death, heart failure requiring diuretics, and/or sustained ventricular arrhythmia. Results: This study comprised 250 patients of whom 181 who were admitted during the COVID-19 outbreak. Baseline characteristics were similar among groups. There was a reduction in door-to-angiography time from 29 h in 2019 to 19 h in 2020 [p = 0.01] and 20 h in 2021 [p = 0.02]. PCI intervention increased from 31.8% in 2019% to 50.0% in 2020 [p = 0.05] and 54.7% in 2021 [p < 0.01]. Median length-of-stay (LOS) was reduced from 3 days in 2019 to 2 days in 2020 [p = 0.03]. There was no significant change in outcomes in COVID-19 cohorts compared to control year. Conclusions: NSTEMI patients during the first 2 years of the COVID-19 pandemic were associated with reduced door-to-angiography times and increased percutaneous coronary intervention (PCI), and patients in year one were associated with reduced LOS. This study suggests that NSTEMI may be managed more efficiently thus reducing hospital bed utilization and potential costs.
    • The Effect of Adenosine in the Phenotype of Gingival Fibroblasts

      Serrano-Lopez, Rogelio; College of Science and Mathematics (Augusta University, 2023-08)
      Our research was focused on the role of gingival fibroblasts in the gingival inflammatory response and in periodontitis. Previous work in our lab has identified adenosine signaling as a key pathway able to control inflammatory chemokine secretion of gingival fibroblasts. The data from human correlative studies comparing chemokine expression in healthy versus periodontitis was combined with our in vitro analysis of immunofluorescence. Our in vitro data from immunofluorescence results demonstrated the effect of adenosine in the inflammatory response of gingival fibroblasts, typified by the expression of CXCL8- family of cytokines, including CXCL1. We demonstrated the anti-inflammatory effect of adenosine on fibroblast phenotype typified by the decreased IL-1β-stimulated CXCL1 expression. CXCL1 was also significantly higher in samples derived from different grades/severity of periodontitis compared to healthy-derived samples in our analysis of a public dataset. Our data indicated fibroblasts have an important role in gingival inflammatory response. In our findings, the expression or production of CXCL1 was abrogated after treating the human gingival fibroblasts with adenosine after IL-1β stimulation. Thus, adenosine may influence the stromal gingival inflammatory response in periodontitis by reducing the fibroblast-mediated activation of inflammatory cells.
    • Effects of Compression Garments on Oxygen Consumption and Heart Rate

      Gilbert, Haley; College of Education (Augusta University, 2023-08)
      For my thesis I will be examining the influence full-leg compression garments have on oxygen consumption and heart rate. It is speculated that compression garments assist with blood flow velocity as well as increasing oxygen delivery to the muscles. It is well known that compression garments aid in recovery and are widely used in the diabetic community to reduce pooling in the lower limbs. What has not been well explored are the benefits to performance during running. Studies show that compression garments reduce muscle oscillation, as well as soft tissue movement (Bringard et al. 2006; Doan et al. 2003). It has been theorized this reduction creates lower stress at the joints and a reduction in injury risk. It is reasonable to question that if compression garments reduce muscle oscillation, then muscle activation time will also be reduced because the muscles will not have to work as hard to counteract the additional oscillating stress at impact. If muscles are not active for as long, then the muscles will not need to produce as much energy or use as much oxygen. With an increase in blood flow and reduction in muscle activation, the heart will not have to work as hard to circulate oxygen and similar effects may occur for heart rate. However, very few studies have examined full-leg compression garments while performing a submaximal endurance run. Therefore, we are testing subjects in full-leg compression garments while performing a 40-minute submaximal effort run to determine the effect on oxygen consumption and heart rate. From a runner's perspective I am intrigued with this topic because I am always looking for new ways to enhance my performance during competition and compression garments could be that next step. By gathering results from this research, it could potentially give us more information on enhancing running performance. In the future we could expand on this research by looking at more variables such as maximal oxygen uptake or examining the effects for longer endurance runs like marathons.
    • The Effects of Quinolinic Acid on Muscles and Bones

      Patel, Rohan; Augusta University (Augusta University, 2023-07-29)
      Quinolinic acid(QA) is an NMDA-receptor agonist associated with several neurological illnesses, including Alzheimer's and Huntington's disease. QA is a metabolite of tryptophan known for its excitotoxic nature in high concentrations. However, in normal conditions its acts as a precursor in the manufacture of nicotinamide adenine dinucleotide (NAD+), a key molecule for energy synthesis. As people age, the quantity of tryptophan and its metabolites, such as QA, fluctuates. With age, QA levels rise, while tryptophan and NAD+ levels decline. QA’s known association with energy production and beneficial properties is overlooked due to its toxic behavior. In this study, we hope to further examine QA through a different perspective by focusing on its potential healing properties rather than its harmful ones. We intend to investigate QA by identifying its effects on muscles and bone marrow stem cells. To decipher its effects, in vitro studies will be conducted. Through this process, we seek to learn if it has therapeutic qualities through cell proliferation and whether it stimulates stem cell differentiation. In the end, we believe that QA, a chemical with a negative connotation, will have notable healing effects on bones and muscles and will be able to provide possible linkage with healthy aging.
    • Impact of Community-based Cancer Initiative on Health Knowledge Regarding Prostate Cancer

      Idun, Barbara; Pamplin College, Augusta University (Augusta University, 2023-06-27)
      Although in recent decades deaths from prostate cancer have declined among all men, Black men in the US are twice as likely as non-Hispanic White men to die of prostate cancer and continue to have the highest prostate cancer mortality among all US population groups (American Cancer Society, 2021). Within the United States this phenomenon becomes more apparent in areas with a high density of Black Americans, for example the state of Georgia. There, disparity can be seen in prostate cancer with a rate of 50.3 deaths per 100,000 versus 18.4 deaths per 100,000 for non-Hispanic White men (Georgia Cancer Data Reports, 2016). Consensus agrees that these health inequalities exist due to a multitude of social, economic, and cultural factors. These include cultural attitudes towards cancer, and accessibility to healthcare. The cost of health inequality is human lives, thus, reducing the disparities seen in the Black American community is imperative. One initiative that has set out to tackle this is the Cancer Health Awareness through screeNinG and Education (CHANGE) program. CHANGE aims to reduce Black American racial disparities in prostate, colorectal, and breast cancer through education, navigation to screening, and provider cultural competency improvement. Researchers used an evidence-based template, with an emphasis on modifiable risk factor prevention (such as smoking or obesity), to develop informative classes on cancer screening eligibility, access to screening at the Georgia Cancer Center, and encouragement of early detection behaviors to promote health knowledge and self-efficacy. The CHANGE initiative presented four community-tailored sessions with a focus on cancer, screening, and modifiable risk factors guided by a trained facilitator. To gather evidence of acquired health knowledge an assessment survey was sent out before and after the sessions took place
    • Child protective services during COVID-19 and doubly marginalized children: International perspectives

      Katz, Carmit; Varela, Natalia; Korbin, Jill E.; Najjar, Afnan Attarsh; Cohen, Noa; Bérubé, Annie; Bishop, Ellen; Collin-Vézina, Delphine; Desmond, Alan; Fallon, Barbara; et al. (2022-09)
      Background: Alongside deficits in children's wellbeing, the COVID-19 pandemic has created an elevated risk for child maltreatment and challenges for child protective services worldwide. Therefore, some children might be doubly marginalized, as prior inequalities become exacerbated and new risk factors arise. Objective: To provide initial insight into international researchers' identification of children who might have been overlooked or excluded from services during the pandemic. Participants and setting: This study was part of an international collaboration involving researchers from Brazil, Canada, Colombia, Israel, South Africa, Uganda, the UK and the USA. Researchers from each country provided a written narrative in response to the three research questions in focus, which integrated the available data from their countries. Method: Three main questions were explored: 1) Who are the children that were doubly marginalized? 2) What possible mechanisms may be at the root? and 3) In what ways were children doubly marginalized? The international scholars provided information regarding the three questions. A thematic analysis was employed using the intersectional theoretical framework to highlight the impact of children's various identities. Results: The analysis yielded three domains: (1) five categories of doubly marginalized children at increased risk of maltreatment, (2) mechanisms of neglect consisting of unplanned, discriminatory and inadequate actions, and (3) children were doubly marginalized through exclusion in policy and practice and the challenges faced by belonging to vulnerable groups. Conclusion: The COVID-19 pandemic can be used as a case study to illustrate the protection of children from maltreatment during worldwide crises. Findings generated the understanding that child protective systems worldwide must adhere to an intersectionality framework to protect all children and promote quality child protection services.
    • A Commentary on Safety Precautions for Otologic Surgery during the COVID-19 Pandemic

      Saadi, Robert A.; Bann, Darrin V.; Patel, Vijay A.; Goldenberg, David; May, Jason; Isildak, Huseyin; Augusta University (2020-06-01)
      There are insufficient data regarding the safety of otologic procedures in the setting of the coronavirus disease 2019 (COVID-19) pandemic. Given the proclivity for respiratory pathogens to involve the middle ear and the significant aerosolization associated with many otologic procedures, safety precautions should follow current recommendations for procedures involving the upper airway. Until preoperative diagnostic testing becomes standardized and readily available, elective cases should be deferred and emergent/urgent cases should be treated as high risk for COVID-19 exposure. Necessary otologic procedures on positive, suspected, or unknown COVID-19 status patients should be performed using enhanced personal protective equipment, including an N95 respirator and eye protection or powered air-purifying respirator (PAPR, preferred), disposable cap, disposable gown, and gloves. Powered instrumentation should be avoided unless absolutely necessary, and if performed, PAPR or sealed eye protection is recommended.
    • Development of a Telemedicine Screening Program During the COVID-19 Pandemic

      Kim, Eileen J.; Kaminecki, Inna; Gaid, Emily A.; Lopez, Michael; Kalia, Megha; Zheng, Jesse; Oliver, Alexander; Xu, Hongyan; Kim, Thomas J.; Seeyave, Desiree; et al. (Mary Ann Liebert, Inc., 2022-08-01)
      Background: Telemedicine use increased during the COVID-19 pandemic due to concerns for patient and provider safety. Given the lack of testing resources initially and the large geographical range served by Augusta University (AU), a telemedicine platform with up-to-date screening guidelines was implemented for COVID-19 testing in March 2020. Our objective was to understand the level of adherence to telemedicine screening guidelines for COVID-19. Methods: The study population included health care providers and population who participated in an encounter in the AU Health Express Care virtual care program from March 22 to May 21, 2020. All encounters were intended to be for COVID-19 screening, free, and available 24 h per day, 7 days per week. Screening guidelines were developed by AU based on information from the Centers for Disease Control and Prevention and the Georgia Department of Public Health. Results: Among 17,801 total encounters, 13,600 were included in the final analysis. Overall adherence to screening guidelines was 71% in the adult population and 57% in the pediatric population. When providers did not follow guidelines, 72% determined that the patient should have a positive screen. Guidelines themselves determined that only 52% of encounters should have a positive screen. Providers' specialty significantly correlated with guideline adherence (p = 0.002). Departments with the highest adherence were psychiatry, neurology, and ophthalmology. No significant correlation was found between guideline adherence and provider degree/position. Conclusions: This study provides proof of concept of a free telehealth screening platform during an ongoing pandemic. Our screening experience was effective and different specialties participated. Our patient population lived in lower than average income zip codes, suggesting that our free telemedicine screening program successfully reached populations with higher financial barriers to health care. Early training and a posteriori knowledge of telemedicine was likely key to screening guideline adherence.
    • Synergistic Effects of Multiple Factors Involved in COVID-19-dependent Muscle Loss

      Cantu, Nicholas; Vyavahare, Sagar; Kumar, Sandeep; Chen, Jie; Ravindra, Kolhe; Isales, Carlos M.; Hamrick, Mark; Fulzele, Sadanand; Augusta University (International Society on Aging and Disease (ISOAD), 2022-04-01)
      The COVID-19 pandemic caused by the novel SARS-CoV-2 coronavirus is an ongoing pandemic causing severe health crisis worldwide. Recovered COVID-19 patients go through several long-term side effects such as fatigue, headaches, dizziness, weight loss, and muscle loss among others. Our study sought to determine the molecular mechanisms behind muscle loss in COVID-19 patients. We hypothesized that multiple factors such as cytokine storm and therapeutic drugs (glucocorticoid and antiviral drugs) might be involved in muscle loss. Using the Gene Expression Omnibus database, we identified several studies that performed RNA sequencing on skeletal muscles with the treatment of cytokine, glucocorticoid, and antiviral drugs. Our study identified cytokines, such as IL-1b, and IL-6, associated with altered regulation of several genes involved in the myogenic processes, including Ttn, Cxxc5, Malat1, and Foxo1. We also observed that glucocorticoid altered the expression of Foxo1, Lcn2, Slc39a14, and Cdkn1a. Finally, we found out that the antiviral (RNA-dependent RNA polymerase inhibitor) drug regulates the expression of some of the muscle-related genes (Txnip, Ccnd1, Hdac9, and Fbxo32). Based on our findings, we hypothesize that the cytokine storm, glucocorticoids, and antiviral drugs might be synergistically involved in COVID-19-dependent muscle loss.