United States

There is currently a gap in knowledge regarding the knowledge, trust, and barriers of the Hispanic community regarding the influenza vaccine. A descriptive, mixed quantitative survey was administered to 100 participants at flu clinics as well as various locations throughout Metro Detroit between September 2023 and September 2024 to identify their levels of knowledge, trust, and barriers regarding influenza vaccination. There were a significant proportion of individuals with misconceptions regarding the vaccine, with 59% of respondents unware that it was safe for pregnant women, and 67% under the belief that it could interact with medications. Reported barriers to vaccination included lack of time (31%) and other/unspecified (47%), while only 12% reported a lack of insurance. Contrary to our hypothesis, our study shows that Hispanic patients of Metro Detroit may have sufficient levels of knowledge and trust regarding the influenza vaccine. Barriers may primarily be time-related, as opposed to access-related.

AMA Research Challenge 2024 

Understanding Vaccine Hesistancy and Barriers to Access in Hispanic Individuals of Metro Detroit

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Abstract Title
Unemployment in Trauma Patients with Substance Use Disorder

Background
People with substance use disorders (SUD) experience disproportionately high rates of unemployment. Challenges in attaining and maintaining employment are exacerbated in trauma patients with SUD. Employment has been associated with positive outcomes for individuals with SUD, though the effect of employment on health service utilization is unknown. This study aimed to explore the relationship between employment, emergency department (ED) utilization, and hospital readmission in trauma patients with SUD. 

Methods
This was a retrospective cohort study of adult (age≥ 18) trauma patients with SUD at a University Level 1 trauma center from January 2021 to December 2022 (n=692). Data was collected through chart review in REDCap. Univariate analyses were calculated using Chi-square, two-tailed t, and Wilcoxon rank sum tests. Multivariable logistic regressions were used to evaluate the primary outcomes: ED utilization (≥1 visit), frequent ED utilization (≥3 visits), and hospital readmission within one year of index encounter. A p-value of ≤0.05 was considered significant.

Results
Unemployed patients (UP) were more often female, older, unhoused, and admitted with a lower injury severity score than employed patients. UP were more likely to experience multiple SUDs and a co-occurring mental health disorder. On multivariable regression, employment status was not an independent predictor of ED utilization (OR 0.943 (0.632, 1.40), p=0.770), frequent ED utilization (OR 1.22 (0.776, 1.91), p=0.392), or hospital readmission (OR 1.31 (0.881, 1.95), p=0.181) within one year. However, having a co-occurring mental health diagnosis and experiencing homelessness were independent positive predictors of ED utilization (OR 2.76 (1.86, 4.15), p<0.001; OR 3.15 (1.94, 5.22), p<0.001), frequent ED utilization (OR 2.88 (1.93, 4.31), p<0.001; OR 3.96 (2.52, 6.28), p<0.001), and hospital readmission (OR 2.09 (1.44, 3.04), p<0.001; OR 1.76 (1.14, 2.72), p=0.011). 

Conclusion
While we did not find an independent association between employment and health care utilization, we identified that risk factors for ED and hospital readmission like housing status and mental health history were more common amongst UP, affirming that employment, housing, and mental health are deeply interconnected in determining healthcare outcomes. These results add to a growing body of literature demonstrating that comprehensive social support is paramount in improving SUD outcomes. Medical advocacy around SUD treatment should prioritize policy and programming that will increase the socioeconomic support provided in standard SUD treatment.

Unemployment in Trauma Patients with Substance Use Disorder

Abstract Title:
Exploring the Link Between Smoking and Short-Term Mortality in Hospitalized COVID-19 Patients: Insights from Population Data
Background
Smoking cigarettes represents a prevalent form of tobacco consumption, with cigarette smoke containing harmful substances like nicotine, tar, and various carcinogens, which contribute to a spectrum of health issues. This study extends the discussion of smoking in the context of the COVID-19 pandemic, where data suggests that non-smokers hospitalized with the COVID-19 virus are more vulnerable to complications.
Methods
To investigate the relationship between smoking history and short-term mortality among COVID-19 patients, publicly accessible deidentified statewide hospitalization records of individuals aged ≥18 from Q2 2020 to Q1 2022 in Texas were utilized. Identification of smokers was performed using ICD-10-CM codes F17200, Z8789, and U071. Three models were employed to assess this link: multilevel logistic regression with propensity adjustment, supported by alternative analyses including propensity score matching and multivariable logistic regression.
Results
Nicotine administration has been observed to increase nAChR7 expression and inhibit pro-inflammatory cytokines like TNF-α, IL-1, and IL-6, while stimulating anti-inflammatory cytokines such as IL-10. Moreover, nicotine's potential dual effect on ACE2 receptors—increasing expression while reducing available binding sites for the COVID-19 virus—has been highlighted. Additionally, nicotine has been shown to inhibit NF-κB, a critical transcription factor in the activation of inflammation in various immune cells, and as an agonist of α7nAChRs, it can reduce cytokine storm mediators such as HMGB1. Notably, smoking has been associated with reduced furin (PCSK3) levels.
Conclusion
In conclusion, nicotine, widely consumed as tobacco smoking and recognized as an addictive substance, may harbor therapeutic potential that necessitates further exploration. Analogous pharmacological agents with high addictive potential are presently utilized for therapeutic purposes with appropriate pharmaceutical protocols. Further research into nicotine's standard processing, therapeutic index, dosing, and other aspects is imperative. Despite the inherent limitations of retrospective studies, nicotine has demonstrated mortality benefits, underscoring the importance of further investigation through prospective studies.

Exploring the Paradoxical Relationship Between Smoking and Short-Term Mortality in Hospitalized COVID-19 Patients: Insights from a Population-Based Cohort Study

Background:

Vaccines are a crucial tool in combating infectious diseases, yet not all vaccines are equally effective for every individual. Variations in vaccine response can be influenced by demographic factors, including age, race, gender, and ethnicity, which are sometimes overlooked in different studies. With the advancements in Artificial Intelligence (AI) and Machine Learning (ML), there is now an opportunity to predict vaccine responses more accurately. While most current models use genetic data, our study focuses on cytokine data—small proteins that affect cell interactions. Cytokine profiling measures these proteins to better understand the immune response. We initiated our investigation with two primary influenza vaccines as a pilot: the Live Attenuated Influenza Vaccine (LAIV) and the Trivalent Influenza Vaccine (TIV). This study marks the first-ever use of ML models to predict vaccine response using cytokine profiling in combination with demographic data, aiming to develop more inclusive models in healthcare.

Methods:

We analyzed cytokine profiles from over 300 participants across six influenza studies using the ImmPort database. Data were collected on days 0 (pre-vaccination), 7, and 28. Statistical analyses, including t-tests and ANOVAs, identified cytokine differences by demographics. Participants were classified as responders or non-responders using Hemagglutination Inhibition Assay (HAI) data. ML models were created using pre-vaccination cytokine profiles and demographic data to predict responses to the LAIV and the TIV.
Results

Cytokine profiles significantly differed (P < 0.05) by demographics, with significant differences found in 45/55 cytokines measured. Cytokines when compared by race had the most significant differences, especially between African American and White participants, followed by age, gender, and ethnicity. For TIV, the K-Nearest Neighbors model was the most accurate for predicting responders, with accuracies of 80%, 67%, and 74% for the two A strains and one B strain. Logistic regression was most successful for LAIV with an accuracy of about 80% per strain.

Conclusion:

Our study demonstrates the value of cytokine profiling and the impact of demographics on vaccine response predictions. The integration of cytokine data with demographic factors in ML models can lead to more personalized healthcare and help address health disparities in vaccine efficacy, especially those facing African Americans. Future work will involve validating these models on larger datasets and exploring additional data types, such as flow cytometry, to enhance global health decision-making.

Leveraging Machine Learning Models and Cytokines to Predict Vaccine Response:
Exploring Demographic Influences

Chronic alcohol consumption is known to widely increase inflammation throughout the body giving rise to increased pain hypersensitivity, particularly in patients who have pre-existing conditions such as spinal disorders. Spondylolisthesis is a condition involving vertebral anterior displacement leading to diffuse lower back pain that can be managed via conservative and surgical interventions. Repeat corticosteroid injections can be performed through a procedure known as transforaminal lumbar epidural steroid injection (TFESI) to manage the acute and chronic pain of spondylolisthesis and other spinal disorders. This study aims to compare the frequency of TFESI procedures in alcohol-dependent spondylolisthesis patients to their non-alcohol-dependent counterparts.

We utilized a national database known as TriNetX which compiles de-identified electronic medical records from multiple healthcare organizations over the past 20 years. Patients undergoing TFESI (Current Procedural Terminology [CPT]: 64483) for spondylolisthesis (International Classification of Diseases, Tenth Revision [ICD-10]: M43.1) were categorized based on the presence of alcohol-related disorders (ICD-10: F10). Cohort A was defined as patients with spondylolisthesis who had alcohol-related disorders. Cohort B was defined as patients with spondylolisthesis who did not have alcohol-related disorders. Propensity score matching for age, sex, ethnicity, body mass index (BMI), type 2 diabetes, and opioid-related disorders minimized confounding variables between the two cohorts. We compared major outcomes using measure-of-association analysis, obtaining p-values, risk ratios (RR), and 95% confidence intervals (CI) for each complication.

Among 72,261 patients who underwent TFESI procedures for spondylolisthesis, 767 patients had alcohol-related disorders. After matching, alcohol-related disorders were linked to increased future instances of TFESI procedures (p < 0.0001, RR = 1.28, 95% CI = 1.15-1.43) and lower back pain (p < 0.0001, RR = 1.17, 95% CI = 1.09-1.26).

These findings suggest that alcohol-related disorders are associated with increased utilization of TFESI in patients with spondylolisthesis. These patients may experience more severe pain and poorer functional outcomes, necessitating more frequent interventions. Clinicians should consider the impact of alcohol-related disorders when developing a treatment plan for each individual.

Alcohol-Related Disorders Lead to Increased Transforaminal Lumbar Epidural Steroid Injection (TFESI) Use for Patients with Spondylolisthesis

Dronabinol, a synthetic form of delta-9-tetrahydrocannabinol (THC), holds a significant and expanding role in the medical field. Its approval for various medical conditions, such as alleviating chemotherapy-induced nausea and stimulating appetite in HIV-associated cachexia, is well-documented (Ahmedzai, 2004; Beal, 1995). However, its relevance is now extending into pain management and perioperative care.

Recent research, as indicated by Abrams (2011), suggests that Dronabinol possesses potential as both an antiemetic and analgesic agent, particularly in situations where conventional treatments have limitations. This is particularly significant in the context of the opioid crisis, as Dronabinol offers pain relief without the same associated risks as opioids.

As the medical community seeks alternative solutions to opioid-based pain management, Dronabinol's multifaceted relevance becomes increasingly evident. Supported by a body of clinical trials and research reviews, Dronabinol emerges as a valuable tool in addressing various medical challenges.

The reduction in opioid requirements post-surgery, as seen in the case presented, underscores the potential of Dronabinol in the perioperative setting, and this paper aims to explore its medical, social, economic, and legal aspects comprehensively.

Beyond Opioids: Exploring Dronabinol in Enhanced Recovery After Surgery (ERAS)

Methylene blue is controversially used in the management of refractory vasoplegia and septic shock due to its mechanism of inhibiting guanylate cyclase and decreasing cGMP levels to improve vascular tone. In recent meta-analysis, methylene blue use in septic shock resulted in improvement of hypotension, blood pressure, and cardiac function, while significantly reducing mortality and ICU/hospital stays. Further usage of methylene blue may benefit anaphylactic and drug-induced shock by reducing vasopressor requirements. Administered intravenously, methylene blue peaks at 30 minutes, with effects lasting 48–72 hours, making it a valuable treatment for various shock conditions.


Methylene Blue Use for Refractory Hypotension in Setting of Necrotizing Pancreatitis 

Abstract Title
Postoperative Opioid Use for Regional vs. General Anesthesia in Hip Arthroplasty
Background
Total hip arthroplasty is a commonly performed surgical procedure, especially among elderly patients. Effective anesthesia management significantly influences outcomes and reduces complications. The choice between regional anesthesia (RA) and general anesthesia (GA) remains a subject of ongoing debate. This comprehensive database study aims to compare long-term postoperative opioid usage for pain management between patients who received general anesthesia versus regional anesthesia.
Methods
The study utilized the TriNetX database, comprising deidentified patient information for over 124 million individuals. Subjects with at least two years of follow-up electronic health data were included in the regional (Bupivacaine) and general (Propofol) anesthesia groups. The study focused on patients who underwent total hip arthroplasty (THA) under anesthesia from 2015 to 2021. Propensity score matching was employed in a 1:1 ratio to balance outcome-affecting variables between the two cohorts. Postoperative opioid use was compared across 90 days, 1 year, and 2 years. Statistical analysis, including odds ratios (ORs) and 95% confidence intervals (CIs), was conducted using the TriNetX database.
Results
A total of 253,827 patients underwent THA under anesthesia, with 112,206 under regional anesthesia and 150,930 under general anesthesia. Propensity score matching resulted in 112,205 patients in both the regional and general anesthesia groups. Following matching, statistical analysis revealed no significant differences in opioid use between regional and general anesthesia groups at 90 days [(OR (95% CI), 1.17 (0.96, 1.425)], 1 year [OR (95% CI), 1.123 (0.983, 1.284)], and 2 years [OR (95% CI), 1.105 (0.991, 1.232)].
Conclusion
The findings suggest that regional anesthesia does not provide superior postoperative pain control with reduced opioid consumption compared to general anesthesia. However, regional anesthesia may lead to shorter hospital stays for these patients. Clinicians should consider these results when customizing anesthesia strategies for individual patients, aiming to achieve the most suitable plan based on each patient's specific needs.

Postoperative Opioid Use for Regional vs. General Anesthesia in Hip Arthroplasty

Background: A hemodynamically significant patent ductus arteriosus (HSPDA) is a common concern in the care of premature infants, but its definition remains a challenge and its preferred treatment remains controversial. 

Methods: We sent an electronic survey to the members of the AAP Sections on Neonatal and Perinatal Medicine, Cardiology and Cardiac Surgery and the PediHeartNet online community regarding their diagnosis and treatment of the HSPDA in premature infants.

Results: 382 neonatologists and 124 pediatric cardiologists completed the survey. Formal echocardiographic and clinical scoring systems for PDA were used infrequently (22.1% and 15.5%). Neonatologists and pediatric cardiologists had significantly different (P<0.001) perceptions of the importance in 11 of 14 echocardiographic parameters used to determine a HSPDA. Surgical ligation was less frequently recommended than catheter closure.

Conclusion: This survey reflects the current best practice in the care of HSPDA and suggests an emphasis on imaging based on clinical condition with formal scoring systems used infrequently.. The difference in perceived value of various echocardiographic parameters between neonatologists and cardiologists may contribute to uncertainty in the determination of HSPDA. Despite being a relatively new technology, catheter occlusion of the HSPDA is recommended more frequently than surgical ligation by this cohort.

A Survey Regarding the Care of the Hemodynamically Significant Patent Ductus Arteriosus (HSPDA)

Background
Bicuspid aortic valve (BAV) is the most common congenital heart condition. BAV complications include aortic valve surgery, aortic surgery, infective endocarditis, and aortic dissection. Due to its 10% chance of transmission to offspring and lifetime morbidity burden of >80%, screening of first-degree relatives is recommended for early detection. Several barriers to echocardiographic screening for BAV have been identified, therefore, a cheap and fast “rule-out” BAV tool is appealing. The objective of our study is to create an artificial intelligence (AI)-enabled electrocardiogram (ECG) model to aid the detection of BAV in suspected individuals.
Methods
Between January 1, 1990, and June 30, 2023, 13,066 adults [mean age 58.3±17 years, 46.6% women] with both an ECG and an echocardiographic study within 6 months of each other, were identified from the Mayo Clinic database. Cases were selected as patients with a confirmed BAV diagnosis either by echocardiographic or pathologic report. Controls were selected as patients with an ECG indication of abnormal auscultation, rule out, suspected, or family history of BAV. Patients were excluded if they displayed any of the following criteria: a previous heart surgery or procedure, potential cardiac remodeling conditions(cardiomyopathies, history of chemotherapy or radiation, autoimmune disease, previous known congenital heart disease, heart failure, myxomas, history of endocarditis, rheumatic heart disease, heart transplant and pacemaker). ECGs by patient were randomly shuffled into mutually exclusive training (80%), internal validation (10%), and test (10%) data sets. A convolutional neural network was built using the Keras Framework under Tensorflow backend (Google;Mountain View,CA,USA).
Results
BAV prevalence in the model’s development was 45%. In the test group, the AI-enabled ECG model achieved an area under the curve (AUC) of 0.704 with the following values: sensitivity 65%, specificity 64.8%, accuracy 64.9%, positive predictive value (PPV) 60.1%, and negative predictive value (NPV) 69.4%.
Conclusion
An AI-enabled ECG model has shown modest diagnostic performance in detecting BAV. When assuming a prevalence of 10% (chance of transmission to offspring), the NPV increases to 94.3% with decreased PPV of 17%. This approach could save a major number of echocardiograms for “ruling-out” BAV, but needs external validation.

Artificial Intelligence-Enabled Electrocardiogram Model for Screening of Bicuspid Aortic Valve

Single ventricle surgical palliation with a Glenn surgery universally leads to unintended pulmonary vascular remodeling with pulmonary arteriovenous malformations (PAVMs) and aortopulmonary collaterals (APCs). The pathogenesis of PAVMs and APCs after Glenn is poorly understood, and published literature is limited. Our research team identified increased macrophages in lung biopsies from patients prior chronic Glenn circulation. Most recently we also identified increased lung macrophages and decreased lung lymphocytes in a surgical animal of Glenn circulation. Because lung macrophages and lymphocytes can originate from the bone marrow and circulate in peripheral blood as monocytes and lymphocytes, we hypothesized that peripheral blood samples from patients with chronic Glenn circulation would demonstrate increased monocytes and decreased lymphocytes compared to age-matched controls. We conducted a retrospective cohort study of patients 0-17 years old who underwent cardiac surgery between 1/1/2012 - 1/1/2024. To assess peripheral blood leukocyte counts, we recorded cell counts from pre-operative complete blood counts (CBC) from patients prior to single ventricle palliation (pre-Glenn and pre-Fontan). We also included age-matched control groups (pre-tetralogy of Fallot surgery and pre-atrial septal defect surgery) because normal leukocyte counts are known to change with age. Patient cohorts were identified through an institutional surgical database and CBCs were recorded through manual chart review immediately prior to the date of surgery. We identified a total of 736 pre-surgical CBCs, including 420 single ventricle CBCs (208 [28.3%] pre-Glenn, 212 [28.8%] pre-Fontan) and 316 control CBCs (156 [21.2%] pre-ASD, 160 [21.7%] pre-TOF). There was no difference in years of age at surgery between our age-matched groups (pre-Glenn 0.35 [0.28, 0.45] vs pre-TOF 0.35 [0.21, 0.50]; p>0.99) (pre-Fontan 3.5 [3.0, 4.1] vs pre-ASD 4.3 [3.0, 7.1]; p=0.19). Compared to their respective age-matched control groups, the pre-Fontan group had increased absolute monocytes (p<0.0001), whereas the pre-Glenn group was not different (p=0.57). Surprisingly, both single ventricle groups had decreased absolute lymphocyte counts (both p<0.0001) and increased absolute neutrophil counts (both p=0.01) compared to their respective control groups. In our single institutional study, chronic Glenn circulation is associated with increased monocytes and decreased lymphocytes in peripheral blood compared to an age-matched control group with an isolated ASD. Further investigation is needed to determine whether peripheral blood leukocyte counts may serve as a biomarker to predict clinical outcomes.

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Understanding Vaccine Hesistancy and Barriers to Access in Hispanic Individuals of Metro Detroit

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