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Recent Submissions

  • Office-Based Pediatric Otoplasty Under Local Anesthesia.

    Hazkour, Nissim; Goote, Paige; Palacios, Jose; Gottfried, Jennifer; Kang, Inkyu; Bastidas, Nicholas (2022-08-09)
    Many parents seek otoplasty for their school age children but fear having to undergo general anesthesia (GA). In our experience, otoplasty can safely be performed in an office-based setting under local anesthesia (LA). There is a gap in the literature regarding pediatric otoplasty under LA.
  • Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States.

    Walsh, Jennifer L; John, Steven A; Quinn, Katherine G; Hirshfield, Sabina; O'Neil, Andrew; Petroll, Andrew E (2022-12-13)
    Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions.
  • The "NUTS" statistic: Applying an EBM disease model to defensive medicine.

    Allen, Robert; Cai, Angela G; Tepler, Peter; deSouza, Ian S (2021-09-15)
    Physicians believe that malpractice concerns result in unnecessary testing, and many emergency physicians state that avoiding malpractice is a contributing factor to ordering medically unnecessary tests. Unfortunately, defensive medicine does not come without possible harm to patients who may be subject to non-beneficial, downstream testing, procedures, and hospitalizations. We submit a novel statistic, "NUTS" or "Number of Unnecessary Tests to avoid one Suit. " We calculated a NUTS of 4737 for troponin testing in ED patients with suspected myocardial infarction, meaning a clinician will need to order 4737 medically unnecessary troponin tests to avoid one missed myocardial infarction lawsuit. The NUTS framework offers us an evidence-based lens to examine defensive medicine less superstitiously and more based on currently available data.
  • Pharmacologic cardioversion of recent-onset atrial fibrillation: a systematic review and network meta-analysis.

    deSouza, Ian S; Tadrous, Mina; Sexton, Theresa; Benabbas, Roshanak; Carmelli, Guy; Sinert, Richard
    We sought to identify the most effective antidysrhythmic drug for pharmacologic cardioversion of recent-onset atrial fibrillation (AF).
  • In Reply to Markey et al.

    deSouza, Ian S; Benabbas, Roshanak (2018-08-22)
  • Antidysrhythmic drug therapy for the termination of stable, monomorphic ventricular tachycardia: a systematic review.

    deSouza, Ian S; Martindale, Jennifer L; Sinert, Richard (2013-09-16)
    We performed a systematic review of the literature to compare the efficacy of different drug therapies for the termination of stable, monomorphic ventricular tachycardia (VT).
  • Assessing the confidence in network meta-analysis results.

    deSouza, Ian S; Allen, Robert; Thode, Henry C (2021-01-11)
  • An unusual case of burning hands.

    Chu, Kathy; deSouza, Ian S (2021-05-13)
    Burning Hands Syndrome is an unusual variant of central cord syndrome. There have been few published reports, and none in the emergency medicine literature. We present a case of Burning Hands Syndrome in which there were no computed tomography (CT) findings of cervical spine injury and only subtle magnetic resonance (MR) abnormalities. We discuss the importance of early diagnosis, as the optimal management of these patients ultimately depends upon prompt recognition of the underlying cervical trauma and a spinal cord at risk for further injury.
  • The soymilk diet: A previously unknown etiology of acute pancreatitis.

    deSouza, Ian S; Lipsitt, Alexander (2021-01-27)
    We present a case of daily, large ingestions of soymilk that likely led to acute pancreatitis. Soybean contains trypsin inhibitor that when ingested will reduce the activity of trypsin in the intestine. A decrease in intestinal proteolytic activity removes the negative feedback on the pancreatic acinar cells, leading to an inappropriate increase in intrapancreatic trypsin secretion. When trypsin activation exceeds the capacity of pancreatic secretory trypsin inhibitor, the subsequent cascade of events can lead to acute pancreatitis.
  • Ventricular tachycardia as a consequence of triggered activity.

    Riggins, John; Douglas, Taylor; deSouza, Ian S (2020-11-07)
    One of the less frequent underlying mechanisms of ventricular tachycardia (VT) is triggered activity. Triggered activity refers to an extrasystole due to a premature depolarization that occurs when the amplitude of an early or delayed afterdepolarization brings the cardiac membrane to its threshold potential. Hydrochlorothiazide and hydroxyzine can prolong repolarization and QT interval and are associated with early afterdepolarizations. Cyclic AMP-mediated, delayed afterdepolarizations can occur as a result of catecholaminergic surge. Delayed afterdepolarization is classically associated with outflow tract (OT) tachycardia, a type of VT that is uniquely defined by its termination with adenosine. We present a case of triggered OT tachycardia for which intravenous amiodarone through its antiadrenergic effect may have been effective. Infusions of magnesium and a cardioselective, β-receptor antagonist that does not prolong repolarization may have been more appropriate given the concurrent, acquired prolonged QT syndrome. After initial stabilization, considering the underlying VT mechanism may prompt the clinician to select the most appropriate, further treatment.
  • Pharmacologic Cardioversion of Recent-Onset Atrial Fibrillation and Flutter in the Emergency Department: A Systematic Review and Network Meta-analysis.

    deSouza, Ian S; Tadrous, Mina; Sexton, Theresa; Benabbas, Roshanak; Carmelli, Guy; Sinert, Richard (2020-03-12)
    We conduct a systematic review and Bayesian network meta-analysis to indirectly compare and rank antidysrhythmic drugs for pharmacologic cardioversion of recent-onset atrial fibrillation and atrial flutter in the emergency department (ED).
  • Fortuitous Identification of Fluctuating AV Block: A Case Report.

    deSouza, Ian S; Dilip, Monisha (2019-05-06)
    Vagally mediated atrioventricular block (AVB) may occur as a result of increased parasympathetic tone. This particular AVB is infrequently described in the literature, but its prevalence may be underestimated, as it may occur without recognition.
  • β-Blockers versus calcium channel blockers for acute rate control of atrial fibrillation with rapid ventricular response: a systematic review.

    Martindale, Jennifer L; deSouza, Ian S; Silverberg, Mark; Freedman, Joseph; Sinert, Richard
    This is a systematic review of the literature to compare the efficacy of calcium channel blockers to β-blockers for acute rate control of atrial fibrillation with rapid ventricular response in the emergency department setting. PubMed, EMBASE, and the Cochrane Registry were searched. Relative risk (95% confidence interval) was calculated between drugs and methodological quality of included studies was evaluated. Of the 1003 studies yielded by our initial search, two met inclusion criteria and provided sufficient data. These were randomized double-blinded studies (n=92) comparing intravenous diltiazem with intravenous metoprolol. The combined relative risk of acute rate control by diltiazem versus metoprolol was 1.8 (95% confidence interval 1.2-2.6). On the basis of the paucity of available evidence, diltiazem may be more effective than metoprolol in achieving rapid rate control, but high-quality randomized studies are needed.
  • Ecstasy (MDMA) deaths in New York City: a case series and review of the literature.

    Gill, James R; Hayes, Jonathan A; deSouza, Ian S; Marker, Elizabeth; Stajic, Marina
    MDMA ("ecstasy") has gained renewed popularity as a drug of abuse. To access the epidemiology and causes of death of MDMA-positive fatalities, all deaths investigated by the OCME that tested positive for MDMA (22 deaths) between January 1997 and June 2000 were reviewed. There were three deaths in each 1997 and 1998, eleven in 1999, and five in the first part of 2000. Of these 22 deaths, 13 were due to acute drug intoxications, 7 due to mechanical injury (blunt trauma, gunshot wounds), and 2 due to a combination of natural disease and acute drug intoxication. Evidence of recent opiate and/or cocaine use was found in 7 of the acute intoxication deaths and in none of the traumatic or combination natural/intoxication deaths. The race of all decedents was White between the ages of 17-41 years, and 18 of 22 were men.
  • Context Matters: Using Genomic Knowledge to Improve Disorder Classification Models

    Faraone, Stephen; Barnett, Eric J. (2023-01)
    Despite heritability estimates that suggest a high ceiling for the classification of many complex genetic disorders, current models have only been moderately successful at accurately classifying cases and controls of these disorders. The knowledge base about the human genome is large and continuously growing, but disorder classification models rarely use any of that information beyond genetic associations. We use three different genomic context data granularities, 4 different machine learning models, and datasets of mood disorders, ADHD, and type 2 diabetes to test hypotheses on whether including genomic context can improve modelling of disorder risk. When predicting whether subjects had been diagnosed with any mood disorder, we found that using polygenic risk scores from other psychiatric disorders in logistic regression models improved classification performance as measured by the area under the receiver operating characteristic curve (AUC). In another study classifying cases of ADHD and controls, we found that the addition of summations of risk based on the genetic variants' inclusion in gene sets associated with ADHD improved AUCs in random forest modelling. The random forest importance scores of those gene set polygenic risk scores showed biological relevance through the correlation of importance scores with relative gene set expression in the brain. In the final study classifying type 2 diabetes cases and controls, for each genetic variant, we attached several types of functional genomic annotations to genotype data. These genomic context informed genotype data were used in convolutional neural networks and significantly improved AUC compared to polygenic risk score models while using a within-model adversarial ancestry task to adjust for potential confounding due to ancestry. In these models, we found that some risk features developed by context informed data overlapped with features developed with standard genotype input while other risk features were unique to the input type. Together, these studies provide evidence that context matters when looking at the disorder risk conferred by genetic variants in complex genetic disorders.
  • How phenotype and developmental stage affect the genes we find: GABRA2 and impulsivity.

    Dick, Danielle M; Aliev, Fazil; Latendresse, Shawn; Porjesz, Bernice; Schuckit, Marc; Rangaswamy, Madhavi; Hesselbrock, Victor; Edenberg, Howard; Nurnberger, John; Agrawal, Arpana; et al. (2013-04-08)
    The detection and replication of genes involved in psychiatric outcome has been notoriously difficult. Phenotypic measurement has been offered as one explanation, although most of this discussion has focused on problems with binary diagnoses.

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