Recent Resident Research

Publication & Presentation

Association of Pre-Existing Medical Comorbidity with Short-Term Mortality in Takotsubo Cardiomyopathy

Courtesy of New England Journal of Medicine

Courtesy of New England Journal of Medicine

Despite generally being considered a reversible disorder, Takotsubo cardiomyopathy (TC) is increasingly associated with significant short-term morbidity and mortality. We sought to examine the association between pre-existing medical comorbidity and short-term mortality in TC.

Nayeri, A., Yuen, A., Huang, C., Cardoza, K., Macdonald, A., Shamsa, K., … Fonarow, G. (2019). Association Of Pre-Existing Medical Comorbidity With Short-Term Mortality In Takotsubo Cardiomyopathy. Journal of the American College of Cardiology, 73(9), 906.

Publication

Blood Pressure and Living Kidney Donors: A Clinical Perspective

Elevated blood pressure (BP), or “hypertension,” has been one of the main exclusion criteria for living kidney donation, as it is a risk factor for renal and cardiovascular disease. The effect of elevated BP in living kidney donors is not well studied or understood; however, it has been shown that the kidney function of hypertensive living kidney donors is not significantly worse post-donation than that of normotensive living kidney donors. In addition, even though living kidney donation itself is not considered to be a risk factor for developing hypertension, there exist certain risk factors (African American or Hispanic descent, obesity, age) that may increase the risk of living kidney donors developing elevated BP postdonation

Rastogi, A., Yuan, S., Arman, F., Simon, L., Shaffer, K., Kamgar, M., Nobakht, N., Bromberg, J. S., & Weir, M. R. (2019). Blood Pressure and Living Kidney Donors: A Clinical Perspective. Transplantation direct, 5(10), e488. https://doi.org/10.1097/TXD.0000000000000939

Spirometric indices of early airflow impairment in individuals at risk of developing COPD: Spirometry beyond FEV1/FVC

The pathophysiologic changes of COPD occur well before spirometry meets the formal diagnostic criteria. Recent literature highlights that many current and former smokers without COPD as defined by FEV1/FVC ration

Hoesterey D, Das N, Janssens W, et al. Spirometric indices of early airflow impairment in individuals at risk of developing COPD: Spirometry beyond FEV1/FVC. Respir Med. 2019;156:58-68. doi:10.1016/j.rmed.2019.08.004

Publication

The Autonomic Nervous System and Ventricular Arrhythmias in Myocardial Infarction and Heart Failure

Courtesy of Jason E. Roediger, CCT, CRAT

In this review, we outline the components of the autonomic nervous system that play an important role in normal cardiac electrophysiology and function. In addition, we discuss changes that occur in the setting of cardiac disease including adverse neural remodeling and neurohormonal activation which significantly contribute to propensity for VT/VF. Finally, we review neuromodulation strategies to mitigate VT/VF which predominantly rely on increasing parasympathetic drive and blockade of sympathetic neurotransmission.

Wu, P, Vaseghi, M. The autonomic nervous system and ventricular arrhythmias in myocardial infarction and heart failure. Pacing Clin Electrophysiol. 2020; 43: 172– 180. https://doi.org/10.1111/pace.13856

A Method of Meaningfully Reflecting on Programmatic Transplant Performance

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In this project we designed a unique approach to assess and reflect on heart transplant performance. The objective was to develop strategies for programs to better identify relative strengths and weaknesses to limit death on the waitlist while maximizing post-transplant survival.

Presentation

Off-Label Use of Venetoclax Combination Therapy in Relapsed/Refractory Acute Myeloid Leukemia: A Single Institution Experience

We evaluated the use of venetoclax in relapsed/refractory acute myeloid leukemia to examine its efficacy and toxicity. This drug is currently approved only for treatment-naive, elderly AML patients. We investigated its off-label use in the relapsed/refractory population.

Gaut D, Burkenroad A, Duong T, Feammelli J, Sasine J, Schiller G. Off-Label Use of Venetoclax Combination Therapy in Relapsed/Refractory Acute Myeloid Leukemia: A Single Institution Experience. University of California Hematologic Malignancies Consortium 2019 Research Symposium. September 20, 2019; UC Davis Health, Sacramento, CA.

Conference Keynote Address

The 1979 Machhu Dam-II Disaster

On August 11, 1979, a little-known irrigation dam failed in western India, leading to thousands of deaths. In part because of a government coverup, the causes and human experiences of the disaster remained in obscurity for decades. Using archival research and semi-structured qualitative interviews, we compiled a social history of the disaster, published as the 2011 book "No One Had a Tongue to Speak.

http://thefloodbook.com/

Clinical Review

Difficult Biliary Cannulation: Historical Perspective, Practical Updates, and Guide for the Endoscopist

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Despite improvements in endoscopic technologies and accessories, development of advanced endoscopy fellowship programs, and advances in ancillary imaging techniques, biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) can still be unsuccessful in up to 20% of patients. This review discussed how the choice of which techniques to employ and how to best employ them should be individualized and take into account the skill of the endoscopist, the disorder being treated, the anatomy of the patient, and the available biomedical literature.

Berry R, Han JY, Tabibian JH. Difficult biliary cannulation: Historical perspective, practical updates, and guide for the endoscopist. World Journal of Gastrointestinal Endoscopy. 2019 Jan 16;11(1):5-21.

The Importance of Obtaining Sexual History in Older Adults: A Teachable Moment

Our Teachable Moment detailed the importance of obtaining a sexual history in older adults, as illustrated by a case we had in clinic in which a patient with unexplained weight loss was found to have HIV/AIDS. He would have been screened for HIV much earlier had a PCP taken a thorough sexual history, as he reported insertive anal intercourse with men as recently as ten years ago, despite identifying as a heterosexual.

Pedley N, Khalili J. The Importance of Obtaining Sexual History in Older Adults: A Teachable Moment. JAMA Intern Med. Published online October 07, 2019. doi:10.1001/jamainternmed.2019.4480

Clinical Research Publication

Cytokine Expression in Treponema Pallidum Infection

scientificanimations.com

The clinical management of patients that remain serofast following treatment for syphilis can be difficult. Here, we investigated whether cytokine measurement could be useful in the differentiation of serofast individuals with or without incident syphilis. We performed cytokine analysis of collected serum samples and processed that data with various statistical tools to build a cytokine model that could be useful to differentiate individuals that require treatment from those who do not. We found candidate cytokines that should be tested for potential application in clinical assays.

Kojima N, Siebert JC, Maecker H, Rosenberg-Hasson Y, Leon SR, Vargas SK, Konda KA, Caceres CF, and Klausner JD. Cytokine expression in Treponema pallidum infection. J Transl Med. 2019; 17:196.

Health and Safety of UCLA Internal Medicine Residents Participating in Short-Term International Clinical Electives

International clinical electives continue to be very popular among resident physicians. However, very little is known about their health and safety while on these electives. The UCLA Department of Medicine Global Health Pathway offers short-term international clinical electives to 25 residents each year to rotate at partner sites in Malawi, Peru, and Thailand. All residents undergo a mandatory pre-departure orientation, which consists of lectures with Infectious Disease faculty and a pre-travel visit with a travel medicine physician. Residents are also directly supervised by a UCLA faculty member on site for the majority of their elective. We surveyed past participants of the electives to determine if there were any significant health or safety issues that they faced or were diagnosed with during or after their electives.

Presentation

Significance of Dedicated Evaluation of Fluid Responsiveness in Early Undifferentiated Shock

We performed a retrospective cohort study with a group of patients admitted to the RRMC ICU with persistent non-cardiogenic shock after receiving 1L of IVF to determine whether those patients identified as being "fluid responsive" would receive a different volume of fluids and have different outcomes than those identified as being "fluid-non-responsive." Fluid responsiveness was determined by a 10% increase in stroke volume with passive leg raise via the validated NICOM carotid Doppler measurement, and all clinicians were blinded to this result. Our primary outcome was total amount and net amount of fluid given at 24 and 72 hours with secondary outcomes including 28-day mortality, length of time on vasopressors/in ICU, need for HD, etc. Our results showed no difference in the primary outcome or mortality, suggesting that clinicians utilizing "standard care" do not treat responders and non-responders differently. However, among responders but not non-responders, mortality and need for HD were significantly greater in the subgroup analysis of those who received a total of more than 30cc/kg. This suggests further research may focus on determining whether fluid responders would benefit from earlier use of vasopressors and more judicious fluid administration.

Book Chapter

Pulmonary Alveolar Proteinosis

Nephron

A book chapter detailing the current state of knowledge regarding pulmonary alveolar proteinosis, including its clinical presentation, epidemiology, diagnosis, pathophysiology, and treatment. The chapter will also include some new advances in the field, as well as clinical trials that are ongoing. The purpose of the chapter is to educate other pulmonary clinicians and researchers within the field in order to guide diagnosis, management, and treatment of pulmonary alveolar proteinosis, as well as to provide information for scientists who are interested in studying this rare lung disease.

Presentation

Activity Assessed by Wrist Actigraphy in the ICU: Are Mechanically Ventilated and Sicker Patients More Inactive?

Using actigraphs (akin to scientific grade Fitbits), we assessed activity in a continuous sample of medical ICU patients and compared to clinical parameters. We analyzed objective continuous measurement of activity in the critically ill, finding that the patients are profoundly inactive.

Publication

Capacity to Address Social Needs Affects Primary Care Clinician Burnout

Primary care clinicians disproportionately report symptoms of burnout, threatening workforce sustainability and quality of care. These symptoms are greater when clinicians perceive fewer clinic resources to address patients’ social needs. This study explores the relationship between burnout and clinic capacity to address social needs.

Reference: Kung A, Cheung T, Knox M, et al. Capacity to address social needs affects primary care clinician burnout. Ann Fam Med. 2019;17(6):487-494. doi:10.1370/afm.2470 (source: https://www.annfammed.org/content/17/6/487.full)