Improving Rates of Nephrology Referral for Patients with Chronic Kidney Disease in Resident Clinic

According to the KDIGO (Kidney Disease Improving Global Outcomes), evaluation by a nephrologist is recommended for patients with CKD stage 4 or higher (corresponding to a GFR of 30 or lower). Studies have shown that patients who are not referred to a nephrologist or referred later suffer from increased complications of renal disease, accelerated progression to ESRD, and have an increased overall mortality rate. At Jefferson Hospital Ambulatory Practice (JHAP), we noted decreased rates of nephrology follow-up in our patients with chronic kidney disease stage 4 and 5. We identified that the most prevalent reason for the decreased referral rates is due to the lack of knowledge of the KDIGO guidelines. Our goals were to implement an intervention to educate our internal medicine residents and improve the referral rates for advanced chronic kidney disease in our practice

A Safety Assessment of the Re-opening of an Academic Medical Center Outpatient Endoscopy Unit During the COVID-19 Pandemic

This study aimed to assess outcomes and satisfaction among patients undergoing outpatient endoscopic procedures during the COVID-19 pandemic Identifying the rates of COVID-19 symptom development and post procedure testing would provide critical information on patient safety Assessment of patient experiences would serve as a guide for potential areas of improvement We predicted that with proper protocols in place, outpatient endoscopy was a safe and positive experienc

Tracking Inflammation in Acute Lung Injury with Chemokine-Specific Peptide v-MIP-II

From the Washington University Undergraduate Research Digest: WUURD, Volume 10, 2014-2015. Published by the Office of Undergraduate Research, Joy Zalis Kiefer Director of Undergraduate Research and Assistant Dean in the College of Arts & Sciences; Stacy Ross, Editor; Kristin Sobotka, Editor; Jennifer Kohl. Mentor: Steven L. Brod

Development of Molecular Markers for Non-Invasive Detection of Lung Inflammation

Advances in the management of acute lung injury and the related adult respiratory syndrome (ARDS) have improved mortality and morbidity rates however, there remains a need for improved non-invasive modes of diagnosis and treatment. Currently, there is no accurate method to image and monitor lung inflammation in these patients. The goal of this study was evaluate the performance of the virus-derived peptide, vMIP-II as a tool to detect lung inflammation using positron emission tomography (PET) lung scanning. vMIP-II binds to a known set of chemokine receptors, molecules that orchestrate inflammatory responses by directing specific cell migration to sites of inflammation. We hypothesized that tracking chemokine receptor activity using the vMIP-II probe would enable us to visualize and monitor lung inflammation. In a mouse model of acute lung injury induced by intratracheal lipopolysaccharide (LPS), intravenously administered radionuclide-labeled probe, 64Cu-DOTA-vMIP-II, resulted in a robust and specific PET signal in the lung at 4 and 24 post injury, but not at 48 h and later. Analysis of single cell preparations of lungs from LPS treated mice injected with fluorescently labeled vMIP-II showed a similar high 24 h and diminished 48 h pattern of cell binding, by flow cytometry. Analysis of immune cell populations using identified specific cell populations that bound the vMIP-II probe only in the acute phase of lung injury. We propose that vMIP-II functions as a sensitive reporter of acute lung injury that can be detected using non-invasive imaging to diagnose and monitor lung injury so that therapies can be rationally administrated

Another Case of Takotsubo Syndrome: Excluded by the Presence of Significant Coronary Artery Disease, or Caused by Significant Coronary Artery Disease?

Takotsubo syndrome (TTS) is a reversible condition of abnormal myocardial contraction that was first given this name in Japan by Dr. Sato in 1991. The name comes from the Japanese word for “octopus trap,” which has a similar shape to that of the left ventricle on ventriculography during Takotsubo syndrome. It is also known as broken heart syndrome, stress-induced cardiomyopathy, or apical ballooning syndrome. The first descriptions of this phenomenon date as far back as the 1960s. TTS typically presents with symptoms and clinical signs suggestive of acute coronary syndrome (ACS). It may include ST segment elevations on electrocardiogram (ECG) characteristic of acute ischemia even though the syndrome is not caused by direct myocardial ischemia. On echocardiography, TTS is usually characterized by segmental wall motion abnormalities (SWMA) with hyperdynamic contraction of the left ventricular basal walls and akinesis of the apical walls. This results in the “apical ballooning” and is notably not in the distribution of typical coronary artery anatomy. Traditionally, the diagnosis of TTS involves the aforementioned findings and coronary angiography showing no obstructive coronary artery disease (CAD). We present here a case of an acute lateral ST-elevation myocardial infarction (STEMI) with subsequent cardiogenic shock due to TTS