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Elbaridi N.,Mercy Hospital and Medical Center | Kaye A.D.,Louisiana State University Health Sciences Center | Choi S.,Harvard University | Urman R.D.,Harvard University
Pain Physician | Year: 2017

Phenylpiperidines are a chemical class of drugs with a phenyl moiety directly attached to piperidine. These agents have an important role in many aspects of medicine including anesthesia and pain medicine. After the development of meperidine, fentanyl, which is a second generation synthetic phenylpiperidine series opioid, was synthesized and introduced into clinical anesthesia practice as fentanyl citrate in 1968. Fentanyl-mediated or modulated responses involve action at the muopioid receptor as an agonist at the dorsal horn inhibiting ascending pain pathways in the rostral ventral medulla, increasing pain threshold, and producing both analgesic and sedative effects. Since fentanyl is metabolized mainly via CYP3A4, potential adverse effects can occur with concomitant use of any drug which affects CYP3A4 activity. Discontinuation of CYP3A4 inducers can also result in an increase in fentanyl plasma concentration. Fentanyl-based formulations can be administered via intravenous, intramuscular, transdermal, transmucosal, and neuraxial routes. We describe the clinical utility of remifentanil, an ultra short-acting analgesic and newer formulations of sufentanil currently being evaluated for acute pain management. We examine the routes of administration and clinical considerations, including the role of opioids such as fentanyl as a natural killer cell suppressive agent. Fentanyl and other opioids have been shown to potentiate propagation of infection and cancer. In recent years, fentanyl and other phenylpiperidine formulations have been developed and successfully marketed for chronic pain management. Because all opioids have complex physiological responses and potential drug-drug interactions, the clinician should appreciate all aspects of this drug class and consider all available options in appropriate clinical settings. © 2017, American Society of Interventional Pain Physicians. All rights reserved.


The International Nurses Association is pleased to welcome Keta A. Mwakiluma, RN, to their prestigious organization with her upcoming publication in the Worldwide Leaders in Healthcare. Keta is a Registered Nurse currently serving patients within the Mercy Hospital and Medical Center in Chicago, Illinois. Now in her second year in nursing, she is a specialist psychiatric nurse. Keta’s career in nursing began in 2016, when she graduated with her Nursing Degree from the North Iowa Area Community College in Mason City, Iowa. An advocate for continuing education, she is currently pursuing her Bachelor of Science Degree in Nursing from the University of Texas at Arlington. Keta has already become known for her enthusiasm and dedication as a nurse. She says that her success is due to the solid foundation that she got from nursing school. In her free time, Keta enjoys traveling, dancing, and spending time with her family and friends. Learn more about Keta A. Mwakiluma here: http://inanurse.org/network/index.php?do=/4136611/info/ and be sure to read her upcoming publication in Worldwide Leaders in Healthcare.


Sakuraba A.,University of Chicago | Keyashian K.,University of Chicago | Melek J.,Mercy Hospital and Medical Center | Melek J.,Alexandria University | And 3 more authors.
Inflammatory Bowel Diseases | Year: 2013

Background: Natalizumab is an efficacious agent for the induction and maintenance of remission in patients with Crohn's disease (CD) who have failed anti-tumor necrosis factor (TNF) agents. We aimed to assess the efficacy and safety of natalizumab outside of clinical trial at a US tertiary center. Methods: Retrospective case review of patients with CD receiving natalizumab. Results: Forty-nine patients with CD (28 women; median age, 33 years) receiving natalizumab from April 2008 to November 2011 were identified. Median duration of disease was 180 months (range, 36-576 months); 40 patients had ileocolonic disease, 1 had ileal disease, and 8 had colonic disease. Twenty-one patients had penetrating disease, and 28 had a history of CD-related surgical treatment. Forty-seven patients previously failed treatment with at least 1 anti-TNF agent. Median duration of natalizumab treatment was 7 months (interquartile range, 3-21.5 months). Twenty-four patients (49%) were continuing natalizumab at the time of this review, and 25 discontinued treatment because of the lack of response, side effects, or positive JC virus antibody. Seventeen patients (35%) successfully continued treatment with natalizumab for longer than 12 months, and nonpenetrating disease phenotype was identified as a predictor of longer response (compared with penetrating phenotype; P = 0.013). Nine patients (18.4%) experienced adverse effects, 5 of which were serious, but no case of progressive multifocal leukoencephalopathy occurred. Conclusions: This is the largest series of natalizumab-treated patients with CD. Our results show that natalizumab is an efficacious and safe treatment agent for patients refractory to anti-TNF agents and that nonpenetrating disease phenotype has more durable response over time. Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.


Sinnott B.,University of Illinois at Chicago | Sinnott B.,Mercy Hospital and Medical Center | Sinnott B.,University of Texas Southwestern Medical Center | Ron E.,U.S. National Institutes of Health | Schneider A.B.,University of Illinois at Chicago
Endocrine Reviews | Year: 2010

Radiation exposure of the thyroid at a young age is a recognized risk factor for the development of differentiated thyroid cancer lasting for four decades and probably for a lifetime after exposure. Medical radiation exposure, however, occurs frequently, including among the pediatric population, which is especially sensitive to the effects of radiation. In the past, the treatment of benign medical conditions with external radiation represented the most significant thyroid radiation exposures. Today, diagnostic medical radiation represents the largest source of man-made radiation exposure. Radiation exposure related to the use of computerized tomography is rising exponentially, particularly in the pediatric population. There is direct epidemiological evidence of a small but significant increased risk of cancer at radiation doses equivalent to computerized tomography doses used today. Paralleling the increasing use of medical radiation is an increase in the incidence of papillary thyroid cancer. At present, it is unclear how much of this increase is related to increased detection of subclinical disease from the increased utilization of ultrasonography and fine-needle aspiration, how much is due to a true increase in thyroid cancer, and how much, if any, can be ascribed to medical radiation exposure. Fortunately, the amount of radiation exposure from medical sources can be reduced. In this article we review the sources of thyroid radiation exposure, radiation risks to the thyroid gland, strategies for reducing radiation exposure to the thyroid, and ways that endocrinologists can participate in this effort. Finally, we provide some suggestions for future research directions. Copyright © 2010 by The Endocrine Society.


Omar H.R.,Mercy Hospital and Medical Center
The American journal of emergency medicine | Year: 2012

ST-segment elevation myocardial infarction is usually caused by plaque rupture and subsequent thrombosis of a single culprit vessel. In rare occasions, simultaneous thrombosis of 2 coronary arteries occurs, which is usually associated with a worse prognosis. Although surgery provokes hemodynamic stress, leading in some instances to myocardial ischemia due to supply/demand mismatch, other factors may also contribute to postoperative myocardial infarction. We present a case of postoperative simultaneous left anterior descending and right coronary stent thrombosis that followed cessation of long-term aspirin therapy in a patient with stable coronary artery disease. This case raises concerns with drug-eluting stents due to the higher potential for late stent thrombosis related to delayed endothelialization of the stent struts. Physicians should be very cautious when deciding to withdraw antiplatelet therapy preoperatively to avoid rebound coronary thrombosis.


Omar H.R.,Mercy Hospital and Medical Center
The American journal of emergency medicine | Year: 2012

Amiodarone is a widely used antiarrythmic drug for various atrial and ventricular arrhythmias. It has the potential to cause prolongation of the QT interval, which, in turn, can increases the incidence of torsade de pointes. Amiodarone is also one of the causes of prominent U waves. The presented case exemplifies the phenomenon of amiodarone-induced T-U fusion and QT prolongation. Other causes of QT prolongation as electrolyte abnormalities or administration of other drugs that prolong the QT interval were excluded. Awareness of this phenomenon and method of calculation of QT interval in this scenario is of utmost importance.


Melek J.,Mercy Hospital and Medical Center | Melek J.,Alexandria University | Sakuraba A.,University of Chicago
Clinical Gastroenterology and Hepatology | Year: 2014

Background & Aims: Patients with inflammatory bowel disease (IBD) are at risk for osteoporosis and fracture. However, the efficacy of medical treatments for osteoporosis in increasing bone mineral density (BMD) in patients with IBD has not been well characterized. Methods: We conducted a meta-analysis and systematic review of controlled trials to evaluate the efficacy and safety of medical therapies used for low BMD in patients with IBD (Crohn's disease, ulcerative colitis, or indeterminate colitis). We searched MEDLINE, EMBASE, Google scholar, the University Hospital Medical Information Network (UMIN) Clinical Trials Registry, and Cochrane Central Register of Controlled Trials for studies that assessed the efficacy of medical treatment for low BMD in patients with IBD. We also manually searched abstracts from scientific meetings and bibliographies of identified articles for additional references. The primary outcome assessed was changes in BMD at the lumbar spine. We also collected data on hip BMD, numbers of new fractures, and adverse effects. Data were pooled by using random-effects models and by mixed-effects analysis for primary aims, when subgroup analysis by individual drug was possible. Results: We analyzed data from 19 randomized controlled studies; 2 used calcium and vitamin D as therapies, 13 used bisphosphonates, 4 used fluoride, 1 used calcitonin, and 1 used low-impact exercise. The pooled effect of bisphosphonates was greater than that of controls in increasing BMD at the lumbar spine (standard difference in means, 0.51; 95% confidence interval, 0.29-0.72) and hip (standard difference in means, 0.26; 95% confidence interval, 0.04-0.49) with comparable tolerability, and the risk of vertebral fractures was reduced. Fluoride increased lumbar spine BMD, but its ability to reduce risk of fracture was unclear. There was no evidence that the other interventions increased BMD. Conclusions: On the basis of a meta-analysis, bisphosphonate is effective and well tolerated for the treatment of low BMD in patients with IBD and reduces the risk of vertebral fractures. There are insufficient data to support the efficacy of calcium and vitamin D, fluoride, calcitonin, or low-impact exercise. However, the small number of randomized controlled trials limited our meta-analysis. © 2014 AGA Institute.


Omar H.R.,Mercy Hospital and Medical Center
Cardiovascular Endocrinology | Year: 2013

Licorice is a US Food and Drug Administration approved food supplement present in various forms without strict policies to regulate its consumption and to prevent toxicity. It is widely utilized as a sweetener, a thirst quencher, in various candies and drinks, and has some medicinal applications. The health benefits of licorice are minor compared to the adverse outcomes of chronic use which is never justified nor recommended. The long-established belief among the community that licorice is a natural healthy substance free of side effects promotes its liberal consumption and predisposition to toxicity. This merits further nationwide education through different media types on the health hazards of chronic licorice intake and the tolerable upper limit of daily ingestion. The main mode of action is through inhibition of the enzyme 11-b-hydroxysteroid dehydrogenase, resulting in a mineralocorticoid effect. This aldosterone-like action is the basic principle for understanding its health benefits and the wide spectrum of adverse effects. Among the various complications associated with excess licorice intake, effects on the cardiovascular system are the most serious. Herein is a review of the various cardiovascular complications associated with licorice intake. I hope that this review will caution physicians, exposed patients, and manufacturing companies against the detrimental effects of licorice and impel the Food and Drug Administration to actively control the use of this substance. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


O'Conor R.,Northwestern University | Wolf M.S.,Northwestern University | Smith S.G.,Northwestern University | Martynenko M.,Mount Sinai School of Medicine | And 5 more authors.
Chest | Year: 2015

BACKGROUND: We sought to investigate the degree to which cognitive skills explain associations between health literacy and asthma-related medication use among older adults with asthma. METHODS: Patients aged 60 years receiving care at eight outpatient clinics (primary care, geriatrics, pulmonology, allergy, and immunology) in New York, New York, and Chicago, Illinois, were recruited to participate in structured, in-person interviews as part of the Asthma Beliefs and Literacy in the Elderly (ABLE) study (n 5 425). Behaviors related to medication use were investigated, including adherence to prescribed regimens, metered-dose inhaler (MDI) technique, and dry powder inhaler (DPI) technique. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of fl uid (working memory, processing speed, executive function) and crystallized (verbal) ability. RESULTS: The mean age of participants was 68 years; 40% were Hispanic and 30% non- Hispanic black. More than one-third (38%) were adherent to their controller medication, 53% demonstrated proper DPI technique, and 38% demonstrated correct MDI technique. In multivariable analyses, limited literacy was associated with poorer adherence to controller medication (OR, 2.3; 95% CI, 1.29-4.08) and incorrect DPI (OR, 3.51; 95% CI, 1.81-6.83) and MDI (OR, 1.64; 95% CI, 1.01-2.65) techniques. Fluid and crystallized abilities were independently associated with medication behaviors. However, when fl uid abilities were added to the model, literacy associations were reduced. CONCLUSIONS: Among older patients with asthma, interventions to promote proper medication use should simplify tasks and patient roles to overcome cognitive load and suboptimal performance in self-care. © 2015 American College Of Chest Physicians.


Barsuk J.H.,Northwestern University | Cohen E.R.,Northwestern University | Potts S.,Mercy Hospital and Medical Center | Demo H.,Mercy Hospital and Medical Center | And 5 more authors.
BMJ Quality and Safety | Year: 2014

Background: Approximately 41 000 central line-associated bloodstream infections (CLABSI) occur annually in US hospitals. We previously developed a simulation-based mastery learning (SBML) curriculum in central venous catheter (CVC) insertion that significantly reduced CLABSI rates. In this study, we evaluated the effect of dissemination of the SBML curriculum on trainee skills and CLABSI rates at a community hospital. Methods: The authors performed a cohort study of residents who rotated in the intensive care unit (ICU) at Mercy Hospital and Medical Center from September 2010 to May 2012. Residents underwent an SBML CVC insertion curriculum and were required to meet or exceed a minimum passing score on a simulated internal jugular (IJ) and subclavian (SC) CVC insertion before ICU patient care. Infection control personnel measured CLABSI rates in the ICU before and after the educational intervention. Results: Residents scored a mean IJ pretest of 35.5% (10.29/29, SD=8.30) compared with a post-test mean of 93.0% (26.96/29, SD=1.50; p<0.001). Their mean SC pretest score was 23.0% (6.68/29; SD=9.58) and increased to 96.1% (27.88/29, SD=1.41) at post-test (p<0.001). Patients experienced 3.82 infections per 1000 catheter-days (20 infections in 5235 catheter-days) in the ICU in the 23 months before the educational intervention. During the 21 months after the intervention, there were 1.29 infections per 1000 catheter-days (six infections in 4670 catheter-days (p=0.019)). The incidence rate ratio derived from the Poisson regression was 0.26 (95% CI 0.09 to 0.74) after controlling for Acute Physiology and Chronic Health Evaluation III score indicating that there was a 74% reduction in the incidence of CLABSI in the medical ICU after the intervention. Conclusions: This study demonstrates successful dissemination and implementation of a CVC SBML curriculum and shows that rigorous medical education is a powerful quality improvement tool.

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