Misha Tori Armstrong’s research while affiliated with University of Miami and other places

Background Necrotizing enterocolitis (NEC) is the most severe and frequent gastrointestinal disease seen in neonatal intensive care units. The purpose of this study was to characterize and correlate disease severity and survival in NEC patients with bloodstream infections (BSI). Methods An institutional database was retrospectively reviewed for all infants with NEC (Bell’s stage II or III) between April 1, 2016 and November 2, 2017. Standard statistical methods were utilized to analyze demographics, need for surgery, survival, and blood culture results. Chi-squared was used to compare categorical variables, t-test for continuous variables, and Cox proportional hazards model for survival analysis. A P < 0.05 was considered significant. Results The cohort consisted of 70 infants with NEC with 11 (16%) having concurrent BSI. Demographics and disease severity were similar between +BSI and –BSI patients (Table 1). Blood cultures from +BSI patients identified Klebsiella (36%), S. Epidermidis (36%), E. coli (18%), and S. Aureus (9%). Positive BSI patients were more likely to require surgery (54.6% vs. 17.0%, P < 0.011). There was a trend toward higher mortality in +BSI patients (P = 0.145), which is reflected in a Kaplan–Meier curve. Significant risk factors for mortality were African American race (P = 0.040), lack of enteral feeds prior to onset (P = 0.014) and need for surgery (P = 0.002). Conclusion This retrospective cohort study elucidated the microbiology related to NEC at a single-center and revealed an association between concurrent bloodstream infections and increased disease severity and need for surgery. Table 1 Demographics BSI + (n = 11) BSI− (n = 59) P-Value Gender (M) 3 (27.3) 29 (49.2) 0.173 African American 6 (54.6) 31 (52.5) 0.064 Hispanic 2 (18.2) 25 (42.4) 0.064 Non-Hispanic White 3 (27.3) 3 (5.1) 0.064 Gestational age (weeks) 28.0(2.53) 27.6(4.56) 0.771 Bell Stage 3 9 (81.8) 39 (66.1) 0.280 Surgery 5 (54.6) 10 (17.0) 0.011 BSI + (n = 11) BSI− (n = 59) P-Value Gender (M) 3 (27.3) 29 (49.2) 0.173 African American 6 (54.6) 31 (52.5) 0.064 Hispanic 2 (18.2) 25 (42.4) 0.064 Non-Hispanic White 3 (27.3) 3 (5.1) 0.064 Gestational age (weeks) 28.0(2.53) 27.6(4.56) 0.771 Bell Stage 3 9 (81.8) 39 (66.1) 0.280 Surgery 5 (54.6) 10 (17.0) 0.011 Table 1 Demographics BSI + (n = 11) BSI− (n = 59) P-Value Gender (M) 3 (27.3) 29 (49.2) 0.173 African American 6 (54.6) 31 (52.5) 0.064 Hispanic 2 (18.2) 25 (42.4) 0.064 Non-Hispanic White 3 (27.3) 3 (5.1) 0.064 Gestational age (weeks) 28.0(2.53) 27.6(4.56) 0.771 Bell Stage 3 9 (81.8) 39 (66.1) 0.280 Surgery 5 (54.6) 10 (17.0) 0.011 BSI + (n = 11) BSI− (n = 59) P-Value Gender (M) 3 (27.3) 29 (49.2) 0.173 African American 6 (54.6) 31 (52.5) 0.064 Hispanic 2 (18.2) 25 (42.4) 0.064 Non-Hispanic White 3 (27.3) 3 (5.1) 0.064 Gestational age (weeks) 28.0(2.53) 27.6(4.56) 0.771 Bell Stage 3 9 (81.8) 39 (66.1) 0.280 Surgery 5 (54.6) 10 (17.0) 0.011 Table 2 Survival Analysis Factor Risk Ratio 95% CI P-Value + BSI 5.3 0.5–56.6 0.145 Male 1.0 1.0–5.3 0.976 African American 4.7 1.1–33.0 0.040 No enteral feeds 5.8 1.5–25.3 0.014 Surgery 17.0 2.8–150.4 0.002 Recurrence 2.9 0.2–11.4 0.172 Factor Risk Ratio 95% CI P-Value + BSI 5.3 0.5–56.6 0.145 Male 1.0 1.0–5.3 0.976 African American 4.7 1.1–33.0 0.040 No enteral feeds 5.8 1.5–25.3 0.014 Surgery 17.0 2.8–150.4 0.002 Recurrence 2.9 0.2–11.4 0.172 Table 2 Survival Analysis Factor Risk Ratio 95% CI P-Value + BSI 5.3 0.5–56.6 0.145 Male 1.0 1.0–5.3 0.976 African American 4.7 1.1–33.0 0.040 No enteral feeds 5.8 1.5–25.3 0.014 Surgery 17.0 2.8–150.4 0.002 Recurrence 2.9 0.2–11.4 0.172 Factor Risk Ratio 95% CI P-Value + BSI 5.3 0.5–56.6 0.145 Male 1.0 1.0–5.3 0.976 African American 4.7 1.1–33.0 0.040 No enteral feeds 5.8 1.5–25.3 0.014 Surgery 17.0 2.8–150.4 0.002 Recurrence 2.9 0.2–11.4 0.172 Disclosures All authors: No reported disclosures.

We suggest that people living with HIV (PLWH) may serve as pre-exposure prophylaxis (PrEP) educators for partners when informed about PrEP. Participants in this study were a convenience sample of PLWH at a public hospital in Miami. A cross-sectional survey assessed the frequency of serostatus disclosure, PrEP awareness, and willingness to recommend PrEP to intimate partners. To evaluate stigma surrounding human immunodeficiency virus (HIV), comfort discussing HIV with family, friends and intimate partners was interrogated. Surveys were completed by 137 participants; 39.5% had potentially sero-discordant sexual partners. Among respondents, 29.2% reported that they 'occasionally' or 'never' disclose HIV status to sexual partners. In all, 66.4% of patients reported that they had never heard of PrEP. After being educated about PrEP, 86.0% of respondents reported that they would encourage partners to use it. Participants were asked how often the subject of HIV comes up in conversations. Most indicated that 'rarely' or 'never' does it come up with friends and family; 46.1% indicated that 'never' or 'rarely' does it come up with partners. In bivariate analyses, participants with prior awareness of PrEP were more likely to indicate higher frequency of conversations regarding HIV with intimate partners. It is concluded that interventions which utilize partner education to increase PrEP uptake should address stigma and knowledge among other barriers.

Pre Exposure Prophylaxis (PrEP), when antiretroviral medication is taken by people who are HIV negative to prevent infection, has proven efficacy in decreasing infections among those at risk for acquiring HIV. Despite FDA approval and recommendation by the WHO, existing barriers to PrEP uptake include cost, access to PrEP care, and provider awareness. Previous studies assessing PrEP awareness among providers demonstrated that healthcare provider training enhances effective implementation of PrEP. Incorporation of education regarding effective HIV prevention strategies, including PrEP, into medical school curricula could be an important tool to increase awareness among physicians. This study evaluated the knowledge and awareness of HIV prevention among medical students and assessed perceptions of adequacy of HIV prevention instruction in current curricula at the University of Miami. From formal medical education classwork, 14.3% reported learning about PrEP. Behavioral counseling (57.1%) and treatment of HIV positive patients (67%) were more commonly taught as prevention measures. Despite this, 72% reported willingness to recommend PrEP to at risk individuals. Opportunity exists to improve medical education regarding evidence-based HIV prevention including PrEP and to ensure that medical students are prepared to implement and support these strategies in their future practices.

Background: Management of velopharyngeal insufficiency (VPI) has traditionally involved surgical repair to improve speech. Posterior pharyngeal augmentation using injectable synthetic materials has been advocated. However, outcomes have been equivocal. More recently, autologous fat injection (AFI) has been advocated for correction of mild to moderate VPI. However, long-term efficacy and safety of this procedure remain unsettled. Methods: A systematic review of the literature was performed. Available studies that reported outcomes of autologous fat velopharyngeal injection for treatment of documented VPI were included. Preclinical animal studies were excluded. Study characteristics, patient demographics, treatment details including fat harvest site, volume injected, and outcome measures were evaluated. Results: Fifteen studies met inclusion criteria, yielding 251 patients who underwent AFI. There was high variability in terms of indications for procedure and reporting of outcomes. Majority of studies required velopharyngeal gap closure of at least 50% in order to undergo AFI. Most common etiology of VPI was secondary to cleft palate. Some studies included patients with velocardiofacial syndromes. Improvements in speech and nasalance were reported in a majority of patients. Major complications were rare. Only 1 patient with graft hypertrophy resulting in obstructive sleep apnea was reported. Conclusion: Autologous fat injection offers a minimally invasive approach to the treatment of VPI. Current literature is limited to small noncomparative studies. These appear to suggest efficacy and safety in mild to moderate patients with VPI. Future prospective studies with standardized technique and objective outcomes are required to definitively establish its safety and efficacy, as well as define patient selection criteria.