Medication Risk and Polypharmacy in Minority Older Adults

Medication Risk and Polypharmacy in Minority Older Adults Rusha Patel, Depts. of Biology and Chemistry, with Dr. Youssef Roman, VCU School of Pharmacy, Dr. Elvin Price, VCU School of Pharmacy, and Dr. Lana Sargent, VCU School of Nursing Introduction: Adverse drug events refer to an individual being harmed due to taking a medication. These risks can include side effects, damage to different organs, senses impairment and more. The older adult population has the highest risk for adverse drug events. Antibiotics and anticoagulants are some examples of medication that cause higher adverse events in the elderly. The Beer’s List also includes drugs and their possible side effects. Anticholinergic can cause confusion and dry mouth, anti-infective can cause pulmonary toxicity, and cardiovascular medication can cause damage to the nervous system and increase toxicity in other organs. These events are preventable with caution, but it is important to recognize which medications are taken and the possible interactions/risks for the elderly. The purpose of this study was to evaluate the number of high-risk medications used by older adults (age 60 and older) living in a low-income community-based housing. Participants included had no history of dementia, Alzheimer’s, or Lewy-body disease. Methods: Data will be collected at senior apartment buildings in the Richmond area and at the VCU Health Clinic through the Richmond Health and Wellness Program (RHWP) among Older Adults. Demographics analysis includes age, sex, race/ethnicity, and housing location. Variables considered in the model include; 1) Social Determinants of Health (SDH) as defined by income, race/ethnicity, and education; 2) Medication risk will be measured by polypharmacy \u3e=5 medications, Anticholinergic burden (ACB) score, drug class, and number of medications on the Beer’s list. Polypharmacy numbers \u3e=5 and \u3e=7 were compared to see how much the difference would be significant. Results: Findings and study hypothesis focus on identifying number of individuals taking high risk medications. When the polypharmacy medication was compared using the chi square statistics, the results were significant with a p-value of 0.02. Conclusions: Study implications have an impact on older adult drug safety. With results being significant, it can be concluded that the number used to compare polypharmacy mattered for these results.https://scholarscompass.vcu.edu/uresposters/1327/thumbnail.jp

Reactive arthritis post-SARS-CoV-2

Reactive arthritis (ReA) following bacterial infection from the urogenital and gastrointestinal tract is widely described but is not typical post-viral infections. This report presents the second case of ReA after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United States. A 45-year-old black male with chronic low back pain was hospitalized for 45 days with coronavirus disease 2019 (COVID-19), complicated due to the development of multiorgan failure managed with intubation, extracorporeal membrane oxygenation, and hemodialysis. He was subsequently discharged to an acute rehabilitation facility where he complained of new-onset pain in his shoulders, left elbow, and left knee three weeks after a negative SARS-CoV-2 test. He was readmitted from his acute rehabilitation facility due to recurrent fever and the development of a swollen, warm left knee. Laboratory studies at readmission showed elevated inflammatory markers, negative extensive infectious disease workup, and aseptic inflammatory left knee synovial fluid without crystals. Testing returned negative for most common antibodies seen in immune-mediated arthritides (e.g., rheumatoid arthritis, systemic lupus erythematosus), as well as for common respiratory and gastrointestinal tract pathogens responsible for viral arthritis. The multidisciplinary inpatient medical team deemed the clinical presentation and laboratory findings most consistent with ReA. The patient received a course of oral corticosteroids, followed by a second course due to the recurrence of symptoms weeks after initial treatment and recovery. The current body of medical literature on SARS-CoV-2 pathophysiology supports plausible mechanisms on how this infection may induce ReA. Such a scenario should be considered in the differential of COVID-19-recovered patients presenting with polyarthritis as prompt steroid treatment may help patient recovery

Fungal Septal Abscess Complicating Maxillary Sinus Fungus Balls in an Immunocompetent Host

Background Fungal infections of the nasal cavity can be destructive entities that are typically seen in immunocompromised hosts. We present a case of a localized fungal abscess of the nasal septum in an immunocompetent host after endoscopic treatment of maxillary sinus fungus balls. Method A 51-year-old woman with a history of asthma and recent treatment with oral steroids presented with bilateral maxillary sinus mycetomas. She underwent endoscopic sinus surgery. The postoperative course was complicated by an asthma flare, which required oral steroids. The patient returned with nasal obstruction, and results of a physical examination were consistent with a nasal septal abscess. Drainage was attempted, and cultures showed fungal elements. The abscess reaccumulated, and the patient was referred to our institution. Operative drainage was performed with placement of a catheter in the septal abscess cavity. Forty-eight hours of amphotericin irrigations were performed through this site. The patient was started on oral antifungal therapy. Results of an immune workup, including testing for human immunodeficiency virus and assessing immunoglobulin levels, were negative. Final fungal cultures grew Scedosporium apiospermum sensitive to voriconazole. The patient completed therapy without further recurrence. Follow-up at 6 months demonstrated no further recurrence of her fungal septal infection. Conclusion Sinonasal fungal infections rarely occur in immunocompetent hosts. The septum may have been seeded during the endoscopic sinus surgery. The use of oral steroids may have been a risk factor for the development of an aggressive nasal septal fungal abscess in this patient. This is the first reported case of a nasal septal abscess in an otherwise immunocompetent host with S. apiospermum

Flap Monitoring - 9

Free tissue transfer, a complex surgical procedure, carries a considerable risk of complications and morbidity when flap failure occurs. However, by promptly identifying signs and symptoms indicating problems with the microvascular anastomosis, potential issues can be addressed early on, potentially preventing the need for further extensive surgeries and ensuring successful salvage of the flap. In this chapter, various techniques and devices designed to monitor the viability of the flap during the early postoperative period are thoroughly examined. These methods aid in the assessment of flap perfusion, oxygenation, and overall viability. Examples include Doppler ultrasound, near-infrared spectroscopy, and clinical observation. By employing these monitoring tools, surgeons can detect potential complications at an early stage, enabling timely intervention and improving the overall outcomes of free tissue transfer procedures. The chapter sheds light on the importance of vigilance in postoperative care and highlights the value of monitoring techniques in preventing flap failure and minimizing associated morbidity

Portrait of a Surgeon: Artificial Intelligence Reflections.

Text-to-image artificial intelligence (AI) programs are popular public-facing tools that generate novel images based on user prompts. Given that they are trained from Internet data, they may reflect societal biases, as has been shown for text-to-text large language model programs. We sought to investigate whether 3 common text-to-image AI systems recapitulated stereotypes held about surgeons and other health care professionals. All platforms queried were able to reproduce common aspects of the profession including attire, equipment, and background settings, but there were differences between programs most notably regarding visible race and gender diversity. Thus, historical stereotypes of surgeons may be reinforced by the publics use of text-to-image AI systems, particularly those without procedures to regulate generated output. As AI systems become more ubiquitous, understanding the implications of their use in health care and for health care-adjacent purposes is critical to advocate for and preserve the core values and goals of our profession

Parental leave and family building experiences among head and neck surgeons in the United States: Career impact and opportunities for improvement

The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported. A survey was electronically distributed to head and neck subspecialty surgeons in the United States. Responses were collected and analyzed. Male surgeons had more children and took significantly less parental leave than women. Thirty percent of respondents reported that parental leave negatively impacted compensation, and 14% reported a delay in promotion due to leave, which impacted women more than men. The vast majority reported they are happy or neutral about covering those on leave. Most respondents utilized paid childcare, and approximately one quarter of respondents spending 11%-20% of their income on childcare. This study illuminates the current disparities regarding parental leave-taking within the subspecialty of head and neck surgery in the United States. Women surgeons are more likely to be impacted professionally and financially

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients.

OBJECTIVE: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients. METHODS: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21). RESULTS: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, CONCLUSION: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group

Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

OBJECTIVES: Microvascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti-fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes. METHODS: Retrospective review of reconstruction for IFS (2010-2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed. RESULTS: Twenty-seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (±5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing. CONCLUSION: Patients with maxillectomy defects from IFS can undergo microvascular-free flap reconstruction with good outcomes while on anti-fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing. LEVEL OF EVIDENCE: IV Laryngoscope, 2023