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Sakhuja A.,University of Michigan | Kumar G.,Phoebe Putney Memorial Hospital | Gupta S.,Childrens Hospital of Michigan | Mittal T.,University of Cincinnati | And 2 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2015

Rationale: Understanding the changing incidence and impact of acute kidney injury requiring dialysis in patients with severe sepsis will allow better risk stratification, design of clinical trials, and guide resource allocation. Objectives: To assess the longitudinal incidence of acute kidney injury requiring dialysis and its impact on mortality in patients with severe sepsis. Methods: Retrospective cohort study of adults (>20 yr) hospitalized with severe sepsis from 2000 to 2009 in the United States using a nationally representative database. Measurements andMainResults:Wecalculated the incidences of acute kidney injury requiring dialysis and mortality over time. We used linear regression to assess temporal trends. We used logistic regression to estimate the odds of acute kidney injury requiring dialysis and mortality. Of the estimated 5,257,907 hospitalizations with severe sepsis, 6.1% had acute kidney injury requiring dialysis. The odds of acquiring acute kidney injury requiring dialysis increased by 14% in 2009 compared with 2000. Mortality in patients with acute kidney injury requiring dialysis was higher (43.6% vs. 24.9%; P,0.001). After multivariable adjustment, odds of mortality declined 61% by the year 2009. Acute kidney injury requiring dialysis remained an independent predictor of mortality in patients with severe sepsis, although its influence on mortality declined with time. Conclusions: Incidence of acute kidney injury requiring dialysis in patients with severe sepsis has increased over time; conversely, associated mortality has declined. The likelihood of demise from acute kidney injury requiring dialysis in patients with severe sepsis has also declined. © 2015 by the American Thoracic Socie.


Franco-Paredes C.,Phoebe Putney Memorial Hospital | Franco-Paredes C.,Hospital Infantil Of Mexico | Womack T.,Phoebe Putney Memorial Hospital | Bohlmeyer T.,Phoebe Putney Memorial Hospital | And 8 more authors.
The Lancet Infectious Diseases | Year: 2015

Cryptococcosis is a fungal disease caused by Cryptococcus neoformans and Cryptococcus gattii. By inhalation and subsequent pulmonary infection, it may disseminate to the CNS and cause meningitis or meningoencephalitis. Most cases occur in immunosuppressed hosts, including patients with HIV/AIDS, patients receiving immunosuppressing drugs, and solid organ transplant recipients. However, cryptococcosis also occurs in individuals with apparently healthy immune systems. A growing number of cases are caused by C gattii, with infections occurring in both immunosuppressed and immunocompetent individuals. In the majority of documented cases, treatment of C gattii infection of the CNS requires aggressive management of raised intracranial pressure along with standard antifungal therapy. Early cerebrospinal fluid evacuation is often needed through placement of a percutaneous lumbar drain or ventriculostomy. Furthermore, pharmacological immunosuppression with a high dose of dexamethasone is sometimes needed to ameliorate a persistently increased inflammatory response and to reduce intracranial pressure. In this Grand Round, we present the case of an otherwise healthy adolescent female patient, who, despite aggressive management, succumbed to C gattii meningoencephalitis. We also present a review of the existing literature and discuss optimum clinical management of meningoencephalitis caused by C gattii. © 2015 Elsevier Ltd.


Joy P.S.,University of Iowa | Kumar G.,Phoebe Putney Memorial Hospital
Cardiology (Switzerland) | Year: 2015

Objectives: The mortality rate for patients with delirium tremens (DT) is 5%. As these patients present with elevated cardiac indices, coexisting DT in acute coronary syndrome (ACS) likely worsens outcomes. Our aim was to examine the outcomes of alcohol withdrawal syndrome (AWS) and DT in patients with ACS. Methods: We used the Nationwide Inpatient Sample (2000-2009) for our study. A multivariable logistic regression model was used to examine the independent association of AWS on inhospital mortality and a multivariable linear regression was used to examine the effect of AWS on inpatient length of stay (LOS). Results: An estimated 2,465,852 admissions with a primary diagnosis of ACS were analyzed. Of these, 4,499 patients had AWS and 3,460 patients had DT. Adjusting for age, gender, race, insurance, hospital characteristics, Charlson's comorbidity index, stent placement and year, the inhospital mortality was significant only for DT (OR 1.56; 95% CI 1.21-2.04). Inpatient LOS was 1.64 (95% CI 1.58-1.73) times higher in those with AWS and 2.33 (95% CI 2.22-2.43) times higher in DT when compared to nonalcoholics. Total hospital charges were higher for patients with AWS and DT when compared to nonalcoholics. Conclusions: Coexisting DT in ACS admissions is associated with increased mortality along with longer inpatient LOS and higher hospital costs. © 2015 S. Karger AG, Basel.


Chastain D.B.,Phoebe Putney Memorial Hospital | Henderson H.,University of Mississippi Medical Center | Stover K.R.,University of Mississippi Medical Center | Stover K.R.,University of Mississippi
Open AIDS Journal | Year: 2015

Risk and manifestations of cardiovascular disease (CVD) in patients infected with human immunodeficiency virus (HIV) will continue to evolve as improved treatments and life expectancy of these patients increases. Although initiation of antiretroviral (ARV) therapy has been shown to reduce this risk, some ARV medications may induce metabolic abnormalities, further compounding the risk of CVD. In this patient population, both pharmacologic and nonpharmacologic strategies should be employed to treat and reduce further risk of CVD. This review summarizes epidemiology data of the risk factors and development of CVD in HIV and provides recommendations to manage CVD in HIV-infected patients. © Chastain et al.; Licensee Bentham Open.


Ejere H.O.,Phoebe Putney Memorial Hospital
Cochrane database of systematic reviews (Online) | Year: 2012

Trachoma remains a major cause of avoidable blindness among underprivileged populations in many developing countries. It is estimated that about 146 million people have active trachoma and nearly six million people are blind due to complications associated with repeat infections. The objective of this review was to assess the effects of face washing on the prevalence of active trachoma in endemic communities. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 8), MEDLINE (January 1950 to September 2011), EMBASE (January 1980 to September 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to September 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 2 September 2011. We checked the reference list of the included trials to identify further relevant trials. We used the Science Citation Index to search for references that cite the studies that are included in the review. We also contacted investigators and experts in the field to identify additional trials. We included randomized or quasi-randomized controlled trials, comparing face washing with no treatment or face washing combined with antibiotics against antibiotics alone. Participants in the trials were people normally resident in endemic trachoma communities. Two review authors independently extracted data and assessed trial quality. Study authors were contacted for additional information. Two clinically heterogeneous trials are included, therefore a meta-analysis was considered inappropriate. This review included two trials with data from a total of 2560 participants. Face washing combined with topical tetracycline was compared to topical tetracycline alone in three pairs of villages in one trial. The trial found a statistically significant effect for face washing combined with topical tetracycline in reducing 'severe' active trachoma compared to topical tetracycline alone. No statistically significant difference was observed between the intervention and control villages in reducing ('non-severe') active trachoma. The prevalence of clean faces was higher in the intervention villages than the control villages and this was statistically significant. Another trial compared eye washing to no treatment or to topical tetracycline alone or to a combination of eye washing and tetracycline drops in children with follicular trachoma. The trial found no statistically significant benefit of eye washing alone or in combination with tetracycline eye drops in reducing follicular trachoma amongst children with follicular trachoma. There is some evidence that face washing combined with topical tetracycline can be effective in reducing severe trachoma and in increasing the prevalence of clean faces. Current evidence does not however support a beneficial effect of face washing alone or in combination with topical tetracycline in reducing active trachoma.


Kandiah P.A.,Emory University | Kumar G.,Phoebe Putney Memorial Hospital
Critical Care Clinics | Year: 2016

Hepatic encephalopathy occurs ubiquitously in all causes of advanced liver failure, however, its implications on mortality diverge and vary depending upon acuity and severity of liver failure. This associated mortality has decreased in subsets of liver failure over the last 20 years. Aside from liver transplantation, this improvement is not attributable to a single intervention but likely to a combination of practical advances in critical care management. Misconceptions surrounding many facets of hepatic encephalopathy exists due to heterogeneity in presentation, pathophysiology and outcome. This review is intended to highlight the important concepts, rationales and strategies for managing hepatic encephalopathy. © 2016 Elsevier Inc.


White C.,Georgia State University | Franco-Paredes C.,Hospital Infantil Of Mexico Federico Gomez | Franco-Paredes C.,Phoebe Putney Memorial Hospital
Clinical Microbiology Reviews | Year: 2015

Despite significant improvements in leprosy (Hansen’s disease) treatment and outlook for patients since the introduction of multidrug therapy (MDT) 3 decades ago, the global incidence remains high, and patients often have long-term complications associated with the disease. In this article, we discuss recent findings related to genetics, susceptibility, and disease reservoirs and the implications of these findings for Hansen’s disease control and health outcomes for patients. We describe the continued difficulties associated with treatment of inflammatory episodes known as “leprosy reactions,” which cause much of the disability associated with the disease and can affect people for many years after MDT is complete. We also discuss some of the contemporary challenges for physicians and patients, including international and internal migration of people affected by the disease. We suggest some important areas of focus for future Hansen’s disease research. © 2015, American Society for Microbiology. All Rights Reserved.


Mendenhall W.M.,University of Florida | Amdur R.J.,University of Florida | Vaysberg M.,University of Florida | Mendenhall C.M.,Phoebe Putney Memorial Hospital | Werning J.W.,University of Florida
Head and Neck | Year: 2011

Background The purpose of this study was to describe the natural history and optimal treatment for head and neck paragangliomas (PGs). Methods Our methods were the review of the pertinent literature. Results PGs are rare tumors seen most commonly in the head and neck. Approximately 90% are sporadic; the remainder are familial and related to mutations of the succinate dehydrogenase (SDH) gene complex. Most PGs are benign and slow growing; 6% to 19% are malignant, as evidenced by the development of metastases. PGs may be treated by complete resection or moderate-dose radiotherapy with a ≥90% likelihood of cure. The optimal radiotherapy dose is approximately 45 Gy/25 fractions/5 weeks. The treatment modality selected depends on the risk of complications. Due to their rarity, the optimal treatment for malignant PGs is unclear. Conclusion PGs may be treated by either complete resection or radiotherapy with a high likelihood of success. Treatment depends on the location and extent of the PG and the morbidity associated with treatment. © 2010 Wiley Periodicals, Inc.


Belakhlef S.,Phoebe Putney Memorial Hospital | Church C.,Phoebe Putney Memorial Hospital | Jani C.,Phoebe Putney Memorial Hospital | Lakhanpal S.,Phoebe Putney Memorial Hospital
Clinical Nuclear Medicine | Year: 2012

Background: The standard PET/CT and 18F-FDG scanning protocols for patients with cancer call for data acquisitions to start 50 to 60 minutes postinjection (PI) of the radiopharmaceutical. This prolonged incubation period allows the concentration of high activity tracer to accumulate in the urinary bladder rendering identification of bladder lesions very difficult, if not impossible. The objective of this study was to identify bladder cancer using a novel PET/CT and 18F-FDG scanning protocol that takes advantage of the angiogenesis observed in malignancies and the kidneys physiology of delayed excretion of 18F-FDG into the urinary bladder. Methods: Early dynamic PET/CT and 18F-FDG scans were performed on 7 consecutive male patients with pathology-confirmed bladder cancer. A series of 5 dynamic scans of 2 minutes each, starting at injection time, were obtained on each patients urinary bladder. Areas of increased 18F-FDG blood flow to the bladder walls were considered suspicious for cancer. Results: Using pathologic report as the gold standard, this new protocol resulted in 5 true positives, 1 true negative, and 1 false positive. The average maximum standard uptake values (SUV max ± SD), at 2 to 4 minutes postinjection, of bladder wall areas with increased and normal blood flow were 2.7 ± 0.7 and 1.1 ± 1.3 g/mL, respectively. Also, the average activity concentration ratios (tumor/blood vessel) of suspected cancerous regions versus time showed a linear pattern with a slope of 2.9. Conclusion: Early dynamic FDG PET images can demonstrate bladder lesions that are obscured by urine activity on routine images at 1 hour. © 2012 by Lippincott Williams & Wilkins.


News Article | February 15, 2017
Site: www.prweb.com

Ultimate Medical Academy is proud to highlight Candace Phillips, a resident of Albany, Georgia and a graduate from UMA’s online Medical Administrative Assistant diploma program. With the help of UMA’s Career Services, Phillips landed a healthcare position before she graduated in March 2016. While launching her career in healthcare, Phillips is also continuing her UMA online education and is on schedule to earn a Medical Administrative Assistant associate degree this year. “It feels absolutely amazing,” Phillips said. “It has been one of my life-time goals to have a career in the medical field. Thanks to UMA, I have completed that goal. Since receiving my diploma, I have been offered so many opportunities at school and at work, which is just fantastic.” On Feb. 2, 2016, she joined Phoebe Putney Memorial Hospital as a Patient Access Specialist. In this role, Phillips is responsible for electronically documenting patient demographics, insurance information, codes, and payments into patient’s medical records. This includes verifying insurance and collecting and posting co-payments and reconciling them daily. She also schedules physician appointments, answers phone calls, scans physician orders, and makes copies of medically related documents. While earning her diploma at UMA, Phillips maintained a 4.0 GPA, was on the Dean’s List every semester and graduated with High Honors. Her Dean’s List certificates hang proudly in her living room and serve as an inspiration for both Phillips and her nine-year-old daughter. “While I was making a 4.0 at UMA, my GPA motivated my daughter to make all A’s on her report card too,” Phillips said. “I wanted my daughter to see that no matter how old you are, never give up, and continue to work toward that goal you have always wanted. That’s what I did.” While Phillips strives to be a role model for her daughter by setting a stellar example that you can achieve your goals through hard work, she in turn derives great motivation from her daughter’s unwavering support – support that only a young girl can provide a proud mom. “My daughter has served as my main inspiration through this entire journey,” Phillips said. “She has encouraged me to do my best and when I received my diploma she was so proud of me.” UMA President Derek Apanovitch said, “Stories like Candace’s are what inspire us to do as much as we can for our students at Ultimate Medical Academy. We offer a wide variety of student services and alumni career resources to ensure that our graduates are on a pathway to success during and after attending UMA. We want them to succeed in their new careers in healthcare.” Phillips added, “I have always said if you have a dream, continue to push for that dream. UMA is one of the schools that will help you push for that dream too.” Ultimate Medical Academy is a nonprofit healthcare educational institution with a national presence. Headquartered in Tampa, Fla. and founded in 1994, UMA offers content-rich, interactive online courses as well as hands-on training at our campuses. UMA students have access to academic advising, one-on-one or group tutoring, résumé and interview coaching, job search assistance, technical support and more. The institution is accredited by the Accrediting Bureau of Health Education Schools (ABHES). Learn more by visiting UltimateMedical.edu.

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