Recent Submissions

  • Factors Influencing Social and Community Participation of People with Spinal Cord Injury in Karnataka, India

    Babu, Heavenna; Sriraman, Sheetal; Karthikbabu, Suruliraj; Sophia, P.; Kumar, Senthil N. S. (Medknow, 2024-01-12)
    Background: Social and community participation are major indicators to assess the adequacy of treatment and rehabilitation in patients with spinal cord injury (SCI). This study examined the relationship between functional independence, level of disability, and social and community participation among people with SCI in India. Materials and method: In this cross sectional study, 110 persons with SCI, aged 18 years and above participated in a community setting, in Karnataka, India. Spinal Cord Independence Measure Version III-self-reporting (SCIM III-SR), Craig Handicap Assessment and Reporting Technique (CHART), and WHO Disability Assessment Schedule 2.0 (WHODAS) were the clinical outcome measures. Spearman's correlation and stepwise multiple linear regression were done to determine association and identify the factors determining the community participation of people with SCI. Results: CHART physical independence had a positive correlation with SCIM self-care (R = 0.446) and SCIM mobility (r = 0.434). CHART cognitive independence (R = -0.38) and CHART mobility (R = -0.396) had a weak correlation with WHODAS. SCIM self-care and SCIM mobility (R2 = 0.34) were determinants of CHART cognitive independence. SCIM respiratory and sphincter management and SCIM self-care (R2 = 0.327) were determinants of CHART mobility. Conclusion: Self-care and mobility of people with SCI determine their ability to successfully reintegrate into the community, warranting a comprehensive community rehabilitation program.
  • The New Urology Match: How Recent Innovations Including Virtual Interviews and Preference Signaling Have Changed Match Outcomes

    Heard, John; Rawal, Rushil Y; Amazan, Bradley; Jeune, Karl-Ray; Freedman, Andrew (Springer Science and Business Media LLC, 2024-01-29)
    Objectives: To determine how recent changes in the urology match occurring from 2021 to 2023, including virtual interviews (VIs) and preference signals (PS), affected match outcomes. Methods: The American Urological Association (AUA) match data from 2021 to 2023 was compared to the 15 years prior. This was obtained from the AUA website and a previous study of public AUA match data. Self-reported applicant characteristics and outcomes from the Urology Residency Applicant Spreadsheet 2021-2023 were compared to the four years prior. Results: Between 2021 and 2023, residency programs offered 43 interviews each, compared to an average of 35 in the 15 years prior. Programs have been receiving more applications each year, from a low of 225 in 2019 to a peak of 347 in 2022. This resulted in an interview offer rate of 13% between 2021 and 2023, compared to 16% in the five years prior. Applicants applied to a mean of 88 programs in 2023, increasing each year since 40 in 2006. Applicants attended 12 interviews on average between 2021 and 2023, compared to 13 in the two years prior. Self-reported applicant data similarly demonstrated that, compared to the four years prior, applicants between 2021 and 2023 applied to more programs (81 vs. 70), had a lower interview offer rate (22% vs. 32%), and a higher interview acceptance rate (90% vs. 75%). Conclusions: During the years with VIs, programs offered more interviews and applicants attended fewer on average, indicating a larger applicant pool was interviewed. Despite the introduction of PS, applicants applied to more programs in 2022 and 2023 than ever before.
  • Gender and disease-inclusive nomenclature consolidation of theragnostic target, prostate-specific membrane antigen (PSMA) to folate hydrolase-1 (FOLH1)

    Ramirez-Fort, Marigdalia K.; Gilman, Casey K.; Alexander, Jacob S.; Meier-Schiesser, Barbara; Gower, Arjan; Olyaie, Mojtaba; Vaidya, Neel; Vahidi, Kiarash; Li, Yuxin; Lange, Christopher S.; et al. (Frontiers Media SA, 2024-02-09)
  • Effects of Probiotics, Prebiotics, and Synbiotics on Messenger RNA Expression of Caveolin-1, NOS, and Genes Regulating Oxidative Stress in the Terminal Ileum of Formula-Fed Neonatal Rats

    D'Souza, Antoni; Fordjour, Lawrence; Ahmad, Asma; Cai, Charles; Kumar, Dharmendra; Valencia, Gloria; Aranda, Jacob V; Beharry, Kay D (Springer Science and Business Media LLC, 2010-05)
    Necrotizing enterocolitis (NEC) afflicts extremely low birth weight neonates, and probiotics reduces its incidence and severity. NO is involved in the pathogenesis of NEC, and caveolin-1 regulates NO signaling. We tested the hypothesis that intestinal caveolin-1 and NOS are deficient in formula-fed neonatal rats and that supplementation with "Florastar Kids" and/or galacto-oligosaccharides and fructo-oligosaccharides preserves caveolin-1 and NOS. At birth (P0), neonatal rat pups were maternally fed or hand-gavaged with or without supplemented formula. Samples from the terminal ileum were analyzed for total NO metabolites, growth factors, and gene expression of caveolin-1, NOS isoforms, and antioxidants. Our data showed that formula feeding with and without supplementation resulted in significant growth restriction. Despite suboptimal nutrition, growth factors involved in intestinal repair and regeneration were increased in the neonatal rat ileum. Caveolin-1, endothelial NOS, and neuronal NOS were simultaneously down-regulated with formula feeding while inducible NOS was up-regulated. Superoxide dismutase and glutathione peroxidase were up-regulated with supplementation. These data provide a probable mechanism for the benefits of supplemented formula for decreasing the severity of NEC by preserving the antioxidant systems.
  • Cytokines and Toll-like receptor signaling pathways in the terminal ileum of hypoxic/hyperoxic neonatal rats: benefits of probiotics supplementation.

    D'Souza, Antoni; Cai, Charles L; Kumar, Dharmendra; Cai, Fayme; Fordjour, Lawrence; Ahmad, Asma; Valencia, Gloria; Aranda, Jacob V; Beharry, Kay D (2012-04-10)
    Oxidative stress and inflammation are associated with the development of inflammatory bowel diseases such as necrotizing enterocolitis. We tested the hypothesis that probiotics, prebiotics or synbiotics (a combination of pre- and probiotics) is effective for prevention of inflammatory responses to formula-feeding in the terminal ileum of neonatal rats.
  • Benefits of pre-, pro- and Syn-biotics for lung angiogenesis in malnutritional rats exposed to intermittent hypoxia.

    Ahmad, Asma; Cai, Charles L; Kumar, Dharmendra; Cai, Fayme; D'Souza, Antoni; Fordjour, Lawrence; Ahmad, Taimur; Valencia, Gloria B; Aranda, Jacob V; Beharry, Kay D (2014-10-11)
    Extremely low birth weight and reduced caloric intake have significant adverse effects on lung development and are risk factors for bronchopulmonary dysplasia. Vascular endothelial growth factor (VEGF) is highly involved in lung microvascular development, and may be affected by nutritional status. To test the hypothesis that suboptimal nutrition decreases VEGF signaling in formula-fed neonatal rats, and to determine whether supplementation with probiotics, prebiotics, or synbiotics ameliorate the effects, rat pups at birth (P0) were placed in room air (RA) or intermittent hypoxia (12%) during hyperoxia (50% O2) from birth to P3. The pups were either maternally-fed; or formula-fed with or without supplementation. Formula-fed pups were separated from their mothers at birth and hand-gavaged every 3 hours. Lung VEGF signaling was determined on P3. In RA, all formula-fed groups were significantly growth suppressed with decreased lung weights. Hyperoxia had a less remarkable effect on body weight; and mean lung weight was lower only in the unsupplemented formula-fed group. Lung VEGF was decreased in all formula-fed RA and hyperoxia groups, except the probiotics group. In RA, sVEGFR-1 levels were elevated in all formula-fed groups except the synbiotics group. However in hyperoxia, sVEGFR-1 levels were higher in the unsupplemented formula group. All genes involved in angiogenesis were downregulated in the formula-fed groups compared to maternally-fed. Formula feeding results in significant malnutrition associated with decreased lung size and lung VEGF levels in neonatal rat pups. Probiotic supplementation prevented the adverse effects of combined hyperoxia and suboptimal nutrition on lung VEGF suggesting preservation of angiogenesis.
  • Growth factors in the fetus and pre-adolescent offspring of hyperglycemic rats

    Fordjour, Lawrence; Cai, Charles; Bronshtein, Vadim; Bronshtein, Mayan; Aranda, Jacob V; Beharry, Kay D (SAGE Publications, 2021-04-29)
    Background: Maternal hyperglycemia influences childhood metabolic syndrome, including obesity and hyperglycemia. We tested the hypothesis that the maternal hyperglycemia influences growth factors in the fetal and pre-adolescent offspring. Methods: Hyperglycemia was induced in pregnant rats on embryonic day (E)16 using streptozocin followed by implantation with insulin or placebo pellets at embryonic day 18 (E18). Fetuses at E20 and pre-adolescent pups at postnatal day 14 (P14) were studied: (1) normal untreated controls (CTL) at E20; (2) hyperglycemic placebo-treated (HPT) at E20; (3) hyperglycemic insulin-treated (HIT) at E20; (4) CTL at P14; and (5) HIT at P14. Fetal and pre-adolescent growth factors were determined. Results: Biomarkers of hypoxia were elevated in the HPT group at E20. This group did not survive to term. Maternal insulin improved fetal survival despite lower fetal body weight at E20, however, at normal birth (postnatal day 0 (P0)) and at P14, body weights and blood glucose were higher than CTL. These high levels correlated with aberrant growth factors. Maternal hyperglycemia influenced glucose-6-phosphate dehydrogenase, glucagon, insulin, interleukin-10, and leptin genes. Conclusions: The impact of maternal hyperglycemia on pre-adolescent glucose and body weight was not a consequence of maternal overnutrition. This suggests an independent link which may affect offspring metabolic health in later life.
  • A Case of Transient Neonatal Diabetes Mellitus Successfully Managed with Basal Rate only Insulin Pump

    Henry, Michael M; Arora, Sumeet; Umpaichitra, Vatcharapan; Kochummen, Elna; Ch’ng, Tong Wooi; Hagerty, Dawn; Ibrahim, Zachary; Perez-Colon, Sheila; Chin, Vivian L; Fordjour, Lawrence (2023-01)
    Introduction: Neonatal diabetes mellitus is a rare condition that presents in the first few weeks to months of life. The neonate presents with low birth weight, dehydration, and hyperglycemia with or without ketoacidosis. Management using insulin drip, subcutaneous insulin injection and continuous subcutaneous insulin infusion (CSII) each present their own challenges. There is risk of hypoglycemia even with tiny doses of insulin. Case: We present a case of transient neonatal diabetes mellitus (TNDM) due to paternal uniparental disomy at the 6q24 region, initially diagnosed late at DOL 29 due to the intermittent nature of hyperglycemia. The patient was born with low birth weight, macroglossia, umbilical hernia, and required repair of bilateral inguinal hernia. The other challenges involve management of insulin administration due to the limited amount of subcutaneous tissue in neonates as well as the minute doses of insulin required. Our patient was successfully managed with the most advanced insulin pump at the time with diluted insulin, using a basal rate-only regimen at total daily dose of 0.01-0.2u/kg/day, which is much lower than reported in the current literature. Additionally, this report shows that by titrating to pre-feed glucose, no episodes of hypoglycemia were noted. She had much less blood sugar variability and remained euglycemic. A 90-degree steel catheter was used successfully. Conclusion: TNDM due to paternal uniparental disomy at the 6q24 region can successfully be treated using basal rate-only CSII regimen, titrated to pre-feed glucoses, and 90-degree steel catheter.
  • The introduction of nursing led bubble-CPAP in a neonatal unit in Ghana: A 32-month observational report

    Fordjour, Lawrence; Washburn, Lisa; Darko, Elizabeth; Koffie, Vivian; Rabiu, Fauziya; Brako, Nana Okai; Sereboe, Nana; Seidel, Corey; King, Bryan; Bodkin, Darren; et al. (Elsevier BV, 2023-10)
    Neonatal deaths account for nearly 50 % of under-five deaths in Ghana with prematurity as the leading factor. Bubble continuous positive airway pressure (bCPAP) is important in treating respiratory distress (RD) associated with prematurity but its use in Africa is challenging. There is limited equipment to care for vulnerable newborns and insufficiently trained healthcare staff. This 32-month observational study describes the characteristics and outcomes of bCPAP treated newborns as a nursing led intervention at a regional referral hospital in Ghana. In May 2014, bCPAP was introduced to newborn intensive care unit (NICU) nursing staff. Three bCPAP machines and supplies were donated by Medical Technology Transfer and Services (MTTS). A training program provided learning opportunities for US-based and Ghanaian staff. Locally collected data included: NICU census, staffing, admitting diagnosis, birth weight, gestational age, Apgar scores, antenatal corticosteroid administration, days on bCPAP, and survival. From May 2014 to December 2016, 189 newborns received bCPAP. The mean ± SD (range) gestational age was 30.0 ± 4.2 (24–42) weeks, birth weight was 1.5 ± 0.7 (0.5–4.25) kg, and bCPAP duration was 3.2 ± 3.3 (0–14) days. In 155 (82.0 %), the admission diagnosis was prematurity with RD. Survival in this group was higher compared to other diagnostic categories and improved as birthweight increased (p < 0.05). Overall, 57.8 % of bCPAP treated newborns survived, but survival decreased during the last 12 months for newborns < 1.5 kg. This study supports the long-term sustainability of a nursing-led bCPAP program in Africa, but positive outcomes may be compromised by staffing, equipment, and resource limitations.
  • Associations between nutrients in one-carbon metabolism and fetal DNA methylation in pregnancies with or without gestational diabetes mellitus

    Kadam, Isma’il; Dalloul, Mudar; Hausser, Jeanette; Huntley, Monique; Hoepner, Lori; Fordjour, Lawrence; Hittelman, Joan; Saxena, Anjana; Liu, Jia; Futterman, Itamar D.; et al. (Springer Science and Business Media LLC, 2023-08-26)
    Background: Gestational diabetes mellitus (GDM), characterized by hyperglycemia that develops during pregnancy, increases the risk of fetal macrosomia, childhood obesity and cardiometabolic disorders later in life. This process has been attributed partly to DNA methylation modifications in growth and stress-related pathways. Nutrients involved with one-carbon metabolism (OCM), such as folate, choline, betaine, and vitamin B12, provide methyl groups for DNA methylation of these pathways. Therefore, this study aimed to determine whether maternal OCM nutrient intakes and levels modified fetal DNA methylation and in turn altered fetal growth patterns in pregnancies with and without GDM. Results: In this prospective study at a single academic institution from September 2016 to June 2019, we recruited 76 pregnant women with and without GDM at 25-33 weeks gestational age and assessed their OCM nutrient intake by diet recalls and measured maternal blood OCM nutrient levels. We also collected placenta and cord blood samples at delivery to examine fetal tissue DNA methylation of the genes that modify fetal growth and stress response such as insulin-like growth factor 2 (IGF2) and corticotropin-releasing hormone (CRH). We analyzed the association between maternal OCM nutrients and fetal DNA methylation using a generalized linear mixed model. Our results demonstrated that maternal choline intake was positively correlated with cord blood CRH methylation levels in both GDM and non-GDM pregnancies (r = 0.13, p = 0.007). Further, the downstream stress hormone cortisol regulated by CRH was inversely associated with maternal choline intake (r = - 0.36, p = 0.021). Higher maternal betaine intake and serum folate levels were associated with lower cord blood and placental IGF2 DNA methylation (r = - 0.13, p = 0.049 and r = - 0.065, p = 0.034, respectively) in both GDM and non-GDM pregnancies. Further, there was an inverse association between maternal betaine intake and birthweight of infants (r = - 0.28, p = 0.015). Conclusions: In conclusion, we observed a complex interrelationship between maternal OCM nutrients and fetal DNA methylation levels regardless of GDM status, which may, epigenetically, program molecular pathways related to fetal growth and stress response.
  • Amniotic membrane allografts: development and clinical utility in ophthalmology

    Lazzaro, Douglas; Rizzuti, Allison; Goldenberg, Adam (Informa UK Limited, 2014-12)
    Amniotic membrane, the innermost layer of the placenta, is a tissue that promotes epithelialization, while decreasing inflammation, neovascularization, and scarring. It is used in the surgical management of a wide variety of ophthalmic conditions where it functions as a graft or patch in ocular surface reconstruction. The development of new preservation techniques, as well as a sutureless amniotic membrane, has allowed for easier, in-office placement, without the disadvantages of an operating room procedure. The purpose of this review is to describe the historical development of amniotic membrane in ophthalmology and to describe its current clinical applications, particularly focusing on recent advances.
  • Scope of resident ophthalmology consultation service and patient follow-up rates at a level 1 trauma center in Brooklyn, New York

    Rizzuti, Allison; Vastardi; Hajee, Mohammedyusuf; Lazzaro (Informa UK Limited, 2013-03)
    Background: The purpose of this study was to investigate the most common reasons for urgent ophthalmology consultations in both the emergency room and inpatient settings at a large public hospital served by a busy ophthalmology residency program, and to track patient follow-up rates. Methods: We reviewed the medical records of all patients evaluated by the ophthalmology consultation service at Kings County Hospital Center from June 2003 to October 2005 using a retrospective hospital-based study design. We categorized emergency room patients and inpatients into traumatic and nontraumatic subgroups, and looked at diagnoses and patient demographics, as well as follow-up patterns for emergency room consultations. Results: In total, 743 patients were evaluated; 436 (59%) were emergency room patients and 307 (41%) were inpatients. Consultation for traumatic eye injury was provided for 399 patients (54%), accounting for 284 (65%) of the emergency room consults and 115 (37.5%) of the inpatient consults. The most common reason for inpatient consultation was to rule out ocular manifestations of systemic disease (57 patients, 29.7%), while the most common final diagnosis for trauma inpatient consultation was orbital wall fracture (59 patients, 51.3%). In total, 262 patients (60%) in the emergency room consultation group returned for follow-up care; 162 (57%) of the trauma patients followed up and 100 (66%) of the nontrauma patients followed up. Conclusion: This study provides a comprehensive analysis of the eye conditions and follow-up rates evaluated by the ophthalmology service at Kings County Hospital Center. By evaluating the follow-up patterns of these patients, we may be able to alter patient counseling to increase patient compliance.
  • Reversible severe pulmonary hypertension and right heart failure with cardiogenic shock due to scurvy: a case report

    Kurnick, Adam; Zaveri, Sahil; Tadayoni, Ashkan; Chandrakumar, Harshith P; John, Sabu (Oxford University Press (OUP), 2023-08-17)
    Background: The systemic complications of vitamin C deficiency, otherwise known as scurvy, have been well-documented in history. Few case reports have documented severe cardiopulmonary complications such as right heart failure (RHF) and pulmonary hypertension (PH). Case summary: A 25-year-old female presented to the hospital with two weeks of progressive fatigue, dyspnoea, myalgias, and arthralgias. She was admitted for symptomatic anaemia requiring transfusion. Her symptoms persisted and she developed severe PH and RHF, complicated by cardiogenic shock and multiple episodes of cardiac arrest. She was found to have severe vitamin C deficiency secondary to a severely self-restricted diet. After repletion of vitamin C, the patient had complete resolution of RHF and PH. Discussion: This case adds to the sparse literature documenting severe cardiopulmonary complications of vitamin C deficiency. We believe that this is the first adult case of scurvy causing RHF and PH leading to cardiogenic shock and episodes of cardiac arrest. There are multiple hypotheses on the pathogenesis of scurvy-associated PH and RHF, including overactivation of hypoxia-inducible transcription factors and deficiency of vitamin C's vasodilatory effect that acts through increased nitric oxide production in endothelial cells. When recognized, early vitamin C repletion may prevent severe cardiopulmonary complications of scurvy.
  • Protein Phosphatase 2A as a Therapeutic Target in Pulmonary Diseases

    Yu, Howard; Zaveri, Sahil; Sattar, Zeeshan; Schaible, Michael; Perez Gandara, Brais; Uddin, Anwar; McGarvey, Lucas R.; Ohlmeyer, Michael; Geraghty, Patrick (MDPI AG, 2023-08-26)
    New disease targets and medicinal chemistry approaches are urgently needed to develop novel therapeutic strategies for treating pulmonary diseases. Emerging evidence suggests that reduced activity of protein phosphatase 2A (PP2A), a complex heterotrimeric enzyme that regulates dephosphorylation of serine and threonine residues from many proteins, is observed in multiple pulmonary diseases, including lung cancer, smoke-induced chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, asthma, and idiopathic pulmonary fibrosis. Loss of PP2A responses is linked to many mechanisms associated with disease progressions, such as senescence, proliferation, inflammation, corticosteroid resistance, enhanced protease responses, and mRNA stability. Therefore, chemical restoration of PP2A may represent a novel treatment for these diseases. This review outlines the potential impact of reduced PP2A activity in pulmonary diseases, endogenous and exogenous inhibitors of PP2A, details the possible PP2A-dependent mechanisms observed in these conditions, and outlines potential therapeutic strategies for treatment. Substantial medicinal chemistry efforts are underway to develop therapeutics targeting PP2A activity. The development of specific activators of PP2A that selectively target PP2A holoenzymes could improve our understanding of the function of PP2A in pulmonary diseases. This may lead to the development of therapeutics for restoring normal PP2A responses within the lung.
  • A Case of Multifactorial Viral Myocarditis

    Zaveri, Sahil; Tagliaferri, Ariana R; Woldemariam, Sara; Aron, Polina; Palacios, Carlos; Melki, Gabriel; Michael, Patrick (Springer Science and Business Media LLC, 2021-10-21)
    We present a case of viral myocarditis in the setting of Coxsackievirus and coronavirus disease 2019 (COVID-19) infection. This case is unique as there were two underlying active infections that could have caused the patient's myocarditis. Though both viruses have been shown to cause myocarditis, it was difficult to differentiate the exact etiology in this particular case. The unique nature of this case presents the opportunity to explore whether further diagnostic workup is warranted.
  • Adolescents as partners in the fight against COVID-19.

    Kest, Helen; Kaushik, Ashlesha; Jagunla, Anne; Shaheen, Somia; Zaveri, Sahil; Fernandez, Ninia; Gupta, Sandeep; Goldberg, David (2021-10-28)
    We report our experience of COVID-19 disease burden among patients aged 0-21 years at two tertiary care institutions in the Northeast and Midwest from New Jersey and Iowa. Our results showed that during the initial surge (March to August 2020) at both geographic locations, majority of COVID-19 disease burden occurred in adolescents and that they were more likely to be hospitalized for COVID-related illnesses, as well as develop severe disease needing intensive care. The study results emphasize the need for providing more targeted interventions toward this group to help prevent disease acquisition and transmission.
  • An Unusual Case of Acute Postoperative Hypokalemic Thyrotoxic Periodic Paralysis

    Isabel, Mora; Zaveri, Sahil; Bhavin, Shah; Dianelys, Mendez; Iqra, Farooqi; Gabriel, Melki; Monisha, Singhal (sPage.direcT, 2022-06-30)
    Thyrotoxic periodic paralysis (TPP) is an acute condition characterized by sudden onset of muscle weakness and paralysis in the setting of hypokalemia. This condition has the highest incidence in Asian males but is becoming increasingly common in individuals of different ethnicities as well. Herein, we present a unique case of a Hispanic male with no previous medical history of hyperthyroidism presenting with symptoms of TPP due to a hypothesized postoperative catecholamine surge. This case highlights the importance of recognizing and treating this condition early to prevent dangerous complications such as arrhythmias and respiratory failure.
  • Arterioureteral Fistula in the Setting of Radical Cystoprostatectomy and Ileal Conduit Creation.

    Zaveri, Sahil; Shah, Bhavin; Soufi, Mazhar; Moszczynski, Zbigniew; Zuberi, Jamshed (2022-04-27)
    Arterioureteral fistulas (AUF) following ileal conduit reconstruction are rare and not well-studied. We present a life-threatening bleed from an AUF due to an ileal conduit urinary diversion. In addition, we identify the challenges in the diagnostic process as well as management strategies. We present a 63-year-old male with ileal conduit reconstruction for bladder cancer with an AUF developing years after the reconstruction, which was ultimately managed with angioplasty.
  • COVID-19 Vaccine Cardiac Complications: A Case Series on Implications of Marijuana in Adolescents With Myopericarditis.

    Zaveri, Sahil; Kest, Helen; Shah, Bhavin; DeBruin, William; Colletti, Mario (2022-05-02)
    We report on two critically ill pediatric patients, aged 16 and 18 years, presenting with acute myopericarditis at a tertiary-care center in New Jersey, United States. Both patients had their severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations, tested negative for SARS-CoV-2, and shared only significant history of asthma. Clinical presentations were similar to acute onset chest pain that worsened with deep inspiration. One patient reported a history of vaping and escalating marijuana use several hours preceding presentation. Both patients had elevated troponin on admission and had ST-segment elevation on electrocardiogram (EKG), thus prompting admission to the pediatric intensive care unit (PICU) for cardiac monitoring. Myopericarditis has multiple etiologies and is a newly described rare complication of the SARS-CoV-2 vaccine. It can also occur as a complication of vaping and frequent marijuana drug use. Our paper highlights the importance of a detailed social and drug history in adolescents presenting with chest pain. The clinical characterization is necessary to promote better case definitions and the design of targeted interventions for this vulnerable group.
  • Mask-Induced Partial Transection of the External Ear Requiring Complex Surgical Reconstruction.

    Koti, Bharat; Zaveri, Sahil; Shah, Bhavin; Anand, Shubhankar; Tagliaferri, Ariana R (2022-05-27)
    During the COVID-19 pandemic, wearing masks to prevent the spread of infection has been imperative. Though many wear N-95 masks with circumferential head straps, the use of surgical ear loop-style masks has increased. Dermatologic complications, such as contact dermatitis, psoriasis, and local irritation, have been described in several reports. One such complication has been pressure injury to the external ear, secondary to friction from the ear loops. While external ear pressure ulcers caused by mask-wearing have already been observed, injuries extensive enough to require surgical reconstruction have yet to be described. Herein, we present a unique case of an elderly male with a severe external ear deformity caused by prolonged, uninterrupted mask-wearing that was treated with a complex ear reconstruction. The pressure caused a full-thickness erosion of the helical and conchal cartilage with partial auricle amputation from constant mask wear. We describe an unusual and interesting problem caused indirectly by the coronavirus pandemic and discuss potential methods to protect oneself against skin injury from mask usage while simultaneously preventing viral transmission.

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