The Wire

  • New tunnel, premium RV section at Talladega Superspeedway on schedule despite weather

    Excerpt:

    Construction of a new oversized vehicle tunnel and premium RV infield parking section at Talladega Superspeedway is still on schedule to be completed in time for the April NASCAR race, despite large amounts of rainfall and unusual groundwater conditions underneath the track.

    Track Chairman Grant Lynch, during a news conference Wednesday at the track, said he’s amazed the general contractor, Taylor Corporation of Oxford, has been able to keep the project on schedule.

    “The amount of water they have pumped out of that and the extra engineering they did from the original design, basically to keep that tunnel from floating up out of the earth, was remarkable,” Lynch said.

  • Alabama workers built 1.6M engines in 2018 to add auto horsepower

    Excerpt:

    Alabama’s auto workers built nearly 1.6 million engines last year, as the state industry continues to carve out a place in global markets with innovative, high-performance parts, systems and finished vehicles.

    Last year also saw major new developments in engine manufacturing among the state’s key players, and more advanced infrastructure is on the way in the coming year.

    Hyundai expects to complete a key addition to its engine operations in Montgomery during the first half of 2019, while Honda continues to reap the benefits of a cutting-edge Alabama engine line installed several years ago.

  • Groundbreaking on Alabama’s newest aerospace plant made possible through key partnerships

    Excerpt:

    Political and business leaders gathered for a groundbreaking at Alabama’s newest aerospace plant gave credit to the formation of the many key partnerships that made it possible.

    Governor Kay Ivey and several other federal, state and local officials attended the event which celebrated the construction of rocket engine builder Blue Origin’s facility in Huntsville.

7 days ago

What does COVID convalesced mean?

(UAB/Contributed, YHN)

As cases of COVID-19 surge, many hospitals are reporting record numbers of COVID-19-positive patients under hospitalized care. Different hospitals report their patient counts in different ways. One term that has been used often is convalesced.

What does that mean?

At UAB Hospital, the term “COVID convalesced” is used when a patient is no longer considered infectious to others and can be moved out of a COVID-specific care unit. Many COVID-convalesced patients remain sick or potentially unable to survive without intensive medical attention and care; but since they are technically not infectious with COVID-19 any longer, they are not factored in the active COVID-19 census. It is important to note that these patients may be experiencing prolonged or severe illness that they would not have experienced had it not been for COVID-19.

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Who are the convalesced?

At UAB Hospital, a COVID-convalesced person could be a range of patients. It could be a patient who has been transferred out of the COVID Intensive Care Unit but still needs ’round-the-clock support, or a patient who was asymptomatic but tested positive for COVID-19 upon admission for a different reason.

“There are some people who are completely asymptomatic and are here for a different reason, but have active COVID-19 illness and still get admitted for the original reason they sought medical care for,” said Rachael Lee, M.D., UAB Hospital’s health care epidemiologist. “However, a vast majority of these cases are people who are critically ill, meaning they are still on the ventilator and, unfortunately because of COVID-19, developed an inflammatory response. This presents when one’s own immune system has revved up and then causes scarring in the lungs. Because of that, we cannot get that patient off of a ventilator, and so they are on the ventilator for long periods of time. After they get off the ventilator, they are weak and debilitated and need rehabilitation. This causes a long stay, initially impacted directly by COVID-19. These patients take a long time to heal.”

A considerable number of patients developed inflammation in the heart and muscle lining. This can be troubling as inflammation in the heart can lead to long-lasting cardiac disease and failure.

Signs of kidney problems in patients with COVID-19 include high levels of protein in the urine and abnormal blood work. The kidney damage is, in some cases, severe enough to require dialysis.

Some people who recovered from COVID-19 reported neurological concerns such as headache, dizziness, lingering loss of smell or taste, muscle weakness, nerve damage, and trouble thinking or concentrating — sometimes called “COVID fog” or “brain fog.”

Lee also added that some patients remain on the ventilator for prolonged periods of time and can develop antibiotic-resistant pneumonias.

Regardless of reason, a convalesced patient still needs a bed and hospitalized support care to get better. Because of the overwhelming amount of COVID-positive and COVID-convalesced patients at UAB Hospital at this time, it does strain the care that is able to be provided across all areas.

Why is it important?

Sharing the convalesced number in addition to the current active cases provides a better look at the impact of COVID-19 on those most affected by the virus and the hospital resources required to care for this patient population. During the current surge, many hospitals are faced with limited bed capacity, and making the public aware of the dire situation while maintaining transparency is paramount.

“Our biggest fear is not being able to treat patients presenting to us for care,” said Vice President of Clinical Support Services at UAB Medicine Sarah Nafziger, M.D. “We are in health care because we like caring for sick people and want to be there for them. Our biggest concern is that demand for our resources outstrips our capacity. We are very concerned that we will not have enough resources to care for the patients presenting to us for care, and that is not just for COVID-19 care.”

(Courtesy of UAB)

2 months ago

UAB team investigates suicide, opioid prescription changes

(UAB/Contributed, YHN)

In a new study, University of Alabama at Birmingham investigators will recruit family members of people who have died by suicide after a change in prescribed pain medications and survey their experiences.

In the United States, suicide rates rose 33 percent from 1999 to 2017, prompting actions by government and nongovernmental agencies, including a new suicide prevention hotline. There is no single explanation for that rise in suicides. Each individual death, experts note, involves a combination of risk factors that can include mental illness, pain, problems accessing care and changes in society at large.

However, starting in 2016, UAB’s Stefan Kertesz, M.D., a professor of medicine, began to see a concerning pattern: Some suicide attempts took place after doctors attempted to reduce prescription of pain medication, including opioids.

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The study, titled Clinical contexts of SuicIde following OPIOID transitionS (CSI:OPIOIDS), will reach out to family members of someone who died by suicide and assess whether they would be willing to collaborate in future research.

Kertesz was not the only person who noticed this new disturbing trend.

Meredith Lawrence was with her husband, Jay Lawrence, when he died by a self-inflicted gunshot wound in March 2017, in Tennessee. At that time, he had severe pain and early-onset dementia. Writing in 2017, Meredith described Jay’s doctors’ plan to reduce prescription opioids as the precipitating factor that contributed to his decision to take his own life. When her story made national news, more than 5,000 comments were posted online. By 2019, the Food and Drug Administration issued a warning that rapidly reducing prescription opioids might cause suicide in some people.

But, Kertesz cautions that suicide is not likely to reflect just one factor, such as how quickly a prescription is changed.

“These events are tragic. Several federal agencies have acknowledged a link between suicide and changes in opioid prescriptions, but no really one understands what is happening,” Kertesz said. “We don’t know why some people wind up dead and others don’t, and that’s why research is needed.”

Co-investigator Allyson Varley, Ph.D., with the UAB Center for Addiction and Pain Prevention and Intervention, added that the medical community and society in general can prevent these terrible losses only by understanding the underlying factors of what took place.

“The problem is there is no official agency attempting to capture these events, and that means they are incredibly hard to study,” Varley said.

Lawrence supports their effort.

“I lost my husband in 2017 by suicide after his medications were taken away,” Lawrence said. “At that point, I wrote about our experience for the public, and it drew attention nationally. To see Dr. Kertesz and his colleagues take this seriously matters to me because nobody should lose a loved one over something treatable.”

Working in collaboration with patients, family members and experts from around the country, Kertesz and Varley have designed a national survey to seek family members who have lost someone to suicide after a change in pain medication. Their survey, which takes about 15 to 20 minutes online or by telephone, will assess how the individual reporting on the death is related to the person who died, and what they think happened. Individuals can participate in the survey online, or by calling staff at the Recruitment and Retention Shared Facility in the Division of Preventive Medicine at UAB.

The study is approved by the Institutional Review Board at UAB.

Both Kertesz and Varley are affiliated with UAB’s Department of Medicine, UAB’s Center for Addiction and Pain Prevention and Intervention, and the Birmingham Veterans Affairs Medical Center.

To participate in this study, click here.

(Courtesy of UAB)

3 months ago

UAB establishes uterus transplant program

(UAB/Contributed, YHN)

The University of Alabama at Birmingham and UAB Medicine have established the first uterus transplant program in the Southeast and the fourth such program in the United States.

Led by Paige Porrett, M.D., Ph.D., associate professor of surgery in the UAB Division of Transplantation and Comprehensive Transplant Institute, the uterus transplantation program will provide women with uterine factor infertility an innovative option for child-bearing using deceased donor organs.

Uterine factor infertility may affect as many as 5 percent of reproductive-age women worldwide and was a previously irreversible form of female infertility. A woman with UFI cannot carry a pregnancy to term either because she was born without a uterus, has had the uterus surgically removed during a hysterectomy, or has a uterus in place that does not function properly. Congenital absence of the uterus is a condition called Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), which affects approximately one out of every 4,500 females, and makes it impossible for a woman to get pregnant.

Most uterus transplants performed to date in the world have been in women with MRKH syndrome. However, women who have undergone a hysterectomy and had the uterus removed surgically are also potential candidates for uterus transplantation.

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“Uterus transplantation is a new and effective treatment for absolute uterine factor infertility, but this important innovation is not yet widely available to women around the world,” Porrett said.

UAB is the first program in the United States to offer uterus transplantation outside of a clinical research trial and is one of very few centers in the world accepting new patients.

“We are tremendously excited to announce that UAB is expanding access to uterus transplantation and offering hope to couples unable to get pregnant,” Porrett said. “Our doors are open to both providers and patients anywhere who want to learn more about this exciting new therapy.”

How uterus transplantation works

The process from transplant to successful birth varies from person to person but can take two to five years for many participants. It includes five phases:

  1. Embryo generation. Before the uterus transplant surgery, a woman generates embryos through in vitro fertilization (IVF). During the process of IVF, she is given fertility drugs to produce eggs, which are then removed from her ovaries and fertilized outside of her body. These embryos are then frozen for later use.
  2. Transplantation. A uterus is removed from a donor and surgically placed into the recipient. The recipient begins taking immunosuppressive medications to prevent rejection of the transplant. These medications are taken while the transplant is in place, including during pregnancy.
  3. Pregnancy. Several months after the transplant surgery, one of the recipient’s embryos will be thawed and placed directly into the uterus. If implantation is successful, the recipient will become pregnant. The health of both baby and mother is monitored very closely at frequent prenatal care visits with a high-risk obstetrician, known as a maternal fetal medicine specialist.
  4. Delivery. The child is born as close to term as is possible via a planned Cesarean section. If the pregnancy has gone well and the recipient and her partner desire a second child, the uterus is left in place and immunosuppression medications are continued. Approximately six months after delivery, another embryo transfer can be attempted.
  5. Uterus removal. After childbearing is complete, the transplanted uterus is removed and immunosuppressive medications are stopped.
(UAB/Contributed)


Unique expertise arrives in Birmingham

Uterus transplantation is no simple task, and that is why Porrett was recruited to lead the program at UAB. Porrett is an abdominal organ transplant surgeon and immunologist who started the third uterus transplant program in the United States at the University of Pennsylvania along with colleagues from the Penn Department of Obstetrics and Gynecology. Porrett was the surgical director of the Penn program and performed all of the uterus transplants to date in that program. Thanks to the outstanding care provided by a team of over 100 people, the transplant and pregnancy outcomes have thus far been excellent, including 100 percent graft survival.

“UAB is committed to providing the most comprehensive and innovative care to vulnerable populations, and we could not be more excited to offer uterine transplantation as a therapy option for women with uterine faculty infertility,” said Jayme Locke, M.D., director of the UAB Comprehensive Transplant Institute. “Dr. Porrett and our comprehensive transplant team of professionals are poised to yet again make a profound impact on the lives of our patients and communities.”

Porrett is a national and international leader in the field and is an NIH-funded specialist in the field of transplant and reproductive immunology. She is currently the secretary of the International Society of Uterus Transplantation and sits on the Vascularized Composite Allograft Transplantation committees for the Organ Procurement and Transplantation Network, as well as several professional transplantation societies. 

“Organ transplantation has been used for many years to save lives, and now it can be used as a tool to generate life,” Porrett said. “That said, neither the tool nor the process is simple. Not every medical center can support it. You need a highly skilled multidisciplinary team with strength at every position. With one of the largest transplant centers in the country and incredible expertise in women’s health, UAB has a very deep bench. Perhaps more important than the expertise on the bench, however, is the grit in each of the players on the team. UAB has a track record of service to complex and historically underserved patients that is second to none. When you add UAB’s spirit of innovation to that profound patient commitment, spectacular things happen. Brains, brawn and heart combine to bring you a kind of magic.”

Specialists in the Comprehensive Transplant Institute and the Department of Obstetrics and Gynecology will work together to provide the best possible comprehensive care.

“The Department of Obstetrics and Gynecology looks forward to collaborating with Dr. Porrett and the entire UAB Comprehensive Transplant Institute on this new initiative in uterine transplantation at UAB,” said Todd Jenkins, M.D., professor in the Department of Obstetrics and Gynecology. “We believe this represents a new frontier in the care of women who would otherwise be unable to experience pregnancy. This program aligns with our overall goal of improving the lives of the women whom we serve.”

Am I a candidate?

Porrett says that candidates for uterine transplants should be generally healthy and without a uterus — either born without one or have had one surgically removed. As part of an intensive evaluation, candidates are educated about the risks of uterus transplantation and counseled about alternatives to uterus transplantation for family building. Porrett encourages any individual interested in uterus transplantation to contact the program for more information. This includes both providers and potential candidates.

To learn more about this program or if you are a candidate, click here or please contact 833-UAB-CTI1.

(Courtesy of UAB)

5 months ago

Why does COVID-19 impair your sense of smell?

(Pixabay, YHN)

There are still many unknowns regarding COVID-19, but one common occurrence among those infected is smell loss. There are many different events that can trigger smell loss, and University of Alabama at Birmingham Assistant Professor Jessica Grayson, M.D., provides insight as to why this might be happening.

Hyposmia or anosmia, a decreased or complete loss of smell, has been widely reported in patients with COVID-19, often as a symptom noticed early on prior to other symptoms or even as the only symptom present in an otherwise asymptomatic patient.

“There have been a significant number of people who have been treated or tested at UAB who have had loss of smell in the setting of their COVID diagnosis,” Grayson said. “However, given the isolation protocols, most of these have only been diagnosed subjectively.”

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Grayson, an assistant professor with the UAB Department of Otolaryngology, says post-viral smell loss is the most common reason for loss of smell. Approximately 40 percent of anosmia is due to post-viral causes. More than 200 different viruses can cause alterations in smell and taste due to temporary or long-term injury to the neural structures.

“If the nose is congested or full of polyps, then the odorant particulates cannot reach the olfactory fibers, which sense the smell and communicate with the brain,” she said. “In other instances, the nose looks relatively normal, but there is local inflammation in the olfactory mucosa that leads to adverse effects on smell.”

Grayson adds that, apart from COVID-19, some people are born with hyposmia or anosmia. These disorders are typically diagnosed once the person is old enough to communicate that they cannot smell, typically during adolescence. In people suffering with obesity, there is also an increased risk of potential smell loss due to benign intracranial hypertension, which causes thinning of the skull base particularly in the region of the cribriform plate because it is already the thinnest region where the olfactory nerves penetrate into the nasal cavity.

“Patients with BIH have also been found to suffer from alterations in smell,” she said. “Trauma, particularly high-velocity head trauma, can cause loss of smell in patients either due to shearing of the olfactory nerves from coup and contrecoup injuries to the head or from direct injury to the olfactory region of the skull base.”

Grayson adds that surgery in the region of the olfactory mucosa that does not preserve this mucosa can also cause smell loss. Tumors arising from the olfactory mucosa, olfactory fibers and anterior cranial fossa can also cause smell loss. Neurodegenerative diseases and inflammatory conditions, like Parkinson’s disease and Sjogrens disease, can also negatively affect smell.

Retraining the nose

Although losing the sense of smell can be quite jarring, Grayson says there are ways to regain that lost sense.

“Patients with post-viral smell loss have roughly a 60-80 percent chance of regaining some of their smell function at one year,” Grayson said. “However, people with traumatic injuries often do not regain smell.”

Smell retraining consists of exposure to certain scents in a repeated nature over many weeks. Patients smell four odor categories — flowery, fruity, aromatic and resinous — every day for 12 weeks and potentially up to six months.

“Studies have shown improvement in smell when patients utilize smell retraining, and some studies have suggested changing the four scents at 12-week intervals,” she said. “When patients performing smell retraining were compared to patients who were not, there were more patients who had improvement in their sense of smell.”

Keen on smelling

Grayson says sense of smell is important for flavoring of food as well as safety reasons.

“The ability to smell is important, because if something is burning, the house is on fire, food has gone bad, a gas leak, brakes burning in your car, you need to be able to have that sense,” she said. “Patients who cannot smell have to have protections in place to prevent bad things from happening like checking smoke detectors monthly, following expiration dates strictly or having someone else in the home who can smell, or having natural gas detectors.”

She says, if you begin to experience a lost sense of smell or taste, COVID-19 testing may be an option.

“Right now, if you lose your sense of smell and taste, you can look for COVID testing, if available,” she said. “However, you can also isolate for 10 days, or 72 hours symptom-free, and follow CDC guidelines.”

Grayson adds that those concerned can reach out to the department, which can send a smell test to complete.

“If we need to do smell retraining based on loss, our team will also get you set up for a follow-up appointment.”

(Courtesy of UAB)

7 months ago

UAB doctor shares her experience treating coronavirus patients in New York

(Gretchen Winter/Contributed, YHN)

As the coronavirus continues to sweep the country, New York City remains one of the areas most affected. A surge of patients left many hospitals understaffed and overwhelmed. One doctor at the University of Alabama at Birmingham saw this as an opportunity to answer the call to help.

Gretchen Winter, M.D., an assistant professor with UAB’s Division of Pulmonary, Allergy and Critical Care Medicine, says her training in critical care and her current position during this time was a perfect combination to allow her to help in New York.

“I felt that I was put in my position with certain skills at this certain time, and I had to believe that was to fulfill the purpose of helping however I could,” Winter said. “I saw the physicians and patients in New York City struggling, and I knew I was able to help, so there wasn’t much of a question. There was a need I could fill, so that’s what I wanted to do.”

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Winter began her journey five weeks ago and has been treating patients at New York-Presbyterian Weill Cornell Medical Center.

Winter says a typical day consists of walking a couple of blocks from her hotel to the hospital to be there at 7 a.m. She then spends her morning reviewing patients’ labs and examining patients, then completing rounds with a team of residents, physician assistants and a critical care fellow.

“We discuss each patient in detail and make plans for their treatment,” Winter said. “The rest of the day is spent making those changes we discussed, adjusting ventilator settings to keep patients comfortable and to optimize their breathing, and putting out fires as they arise. I walk back to the hotel at 7 p.m. Once in my hotel room, I remove my shoes just inside the door and put all clothes and belongings on a ‘COVID’ shelf away from other things. Then I take a shower and wash my hair before venturing into the rest of the room. I normally eat dinner and do a little yoga then go to bed and repeat.”

The combined stress of treating sick patients, being away from home and dealing with the unknown is something that was hard to deal with at times, Winter says. But there were some bright moments.

“The best highs were extubating patients — removing them from the ventilator — and transferring them out of the ICU when they were stable,” Winter said. “And sometimes it was little things, like a patient who opened their eyes when I talked to them after weeks of being unresponsive. I was encouraged seeing people band together to help others, even when it wasn’t their typical role.”

Unfortunately, there was a lot of loss as well.

“Loss of life, loss of abilities, loss of time with loved ones,” said. “That was hard to watch and deal with day after day. It was also difficult being alone and isolated. When I wasn’t working, I was alone in a hotel room. I didn’t have my exercise equipment or my kitchen, so my personal health definitely struggled. I really missed my pets, and several of them were sick while I was gone and had to be taken to the vet and the hospital. It was hard not being there for them when they needed me. I know I was also needed here, but I felt like an inadequate ‘pet mom’ to not be with them when they were hurting.”

As a health care provider on the frontlines, Winter says there are a few things she wishes the public knew about COVID-19 that are not necessarily seen in the headlines.

“I hear people say that only the elderly and sick die from this disease,” she said. “They are incorrect. Yes, many of those who are dying are older or sicker; but I’ve had many young and previously healthy patients fighting for their lives on ventilators and maximal life support.”

After five weeks of treating patients in New York, Winter says she learned a lot during her time there.

“I definitely feel more equipped to treat patients with COVID-19,” Winter said. “I worked with so many people banding together to serve others, and that made me so hopeful. I worked with fellows from other specialties who came back to work as residents, and child life specialists who brought us snacks to lighten our mood, and nurses and physicians from different departments and locations all coming together to serve where needed. Seeing so many people pitch in however they were able was inspiring.”

But, there are also some things that will be hard to get past.

“I also left with a broken heart,” she said. “I am devastated for these patients and their loved ones. I am emotionally and physically exhausted after five weeks of long hours and repetitive loss. I am disheartened to see people gathered socially and refusing to wear masks. After seeing the havoc wrecked by this virus, it is hard for me to balance my hope from so many people helping with my anger at so many people who refuse to follow this guidance. I can only hope that these people will listen and learn. I’m happy to be coming home to help my patients in Alabama. We just really need people to do their part to help keep those patients and each other safe.”

Winter says she is honored to have had the opportunity to serve in New York, but does not want anyone to think she is a hero.

“The doctors and nurses and other hospital staff who have been working week after week long before I came deserve all the praise and the recognition,” Winter said. “These people fought tirelessly to save lives, not because there was publicity or recognition, but because it was the right thing to do. I am blessed to have served alongside them for a few weeks, and I am leaving a better person because I knew them.”

For more coronavirus information, visit uab.edu/coronavirus.

(Courtesy of UAB)

9 months ago

Working behind the scenes: UAB pathologists play key role in fighting coronavirus pandemic

(UAB/Contributed, YHN)

Pathologists at the University of Alabama at Birmingham have been a crucial part of battling the COVID-19 pandemic in Alabama.

Testing has been a major cause for concern worldwide ever since the pandemic began, but clinicians and researchers with UAB’s Department of Pathology have been working around the clock to make testing available for as many people as possible, making sure accurate results are available in a timely manner.

“Our department faculty and staff have been both proactive and nimble in our response to the COVID-19 pandemic,” said Department of Pathology Chair George Netto, M.D. “Pathologists and laboratory medicine professionals, both here at UAB and nationally, have been at the forefront of fighting this pandemic. As always, we are used to working behind the scenes; however, this event has allowed our colleagues to step up and retool their labs and staff to pivot toward tackling COVID-19.”

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Due to UAB’s efforts in molecular testing led by Assistant Professor Sixto Leal, M.D., UAB was among the first academic medical centers in the country to offer in-house testing by launching a laboratory-developed test in March. Leal and his team are currently testing between 300 and 500 samples daily with COVID-19 RNA testing, confirming the presence of the virus in patients, with a turnaround time of less than 24 hours. This includes all inpatient admissions and health care workers, as well as all patients undergoing surgical procedures at UAB Hospital, and labor and delivery patients. A second COVID-19 RNA testing platform with less than two hours’ turnaround time is now operational.

“Our ability to scale up to high-throughput testing platforms has allowed us to support rural and affiliate hospitals throughout our county and state,” Netto said. “We have faculty working full time in more than half a dozen smaller hospitals around the state, filling a crucial need in these areas.”

As one of the top academic medical centers in the nation and a recognized leader in quality patient care, UAB Hospital has partnered with the Jefferson County Department of Health to help provide the first appointment-based community coronavirus testing site. Workers at the downtown Birmingham site have currently tested more than 4,000 people to date.

Jordan DeMoss, vice president for Clinical Operations at UAB Hospital, says safety, efficiency and access to the community for testing were the main objectives for this site.

“Our main goal with a drive-through testing site is really to limit the exposure of our staff as we try to figure out who is positive and who isn’t,” DeMoss said. “It’s so important for us to provide that access across our community, and this site allows us to do that in a safe and accessible way.”

Many experts across the country claim nationwide testing is needed to help determine the spread of the virus and to assist in our return to clinical and research operations, and Netto says that, in this unprecedented time, there have been quite a few challenges, but the work of the department speaks for itself.

“Our team has adapted to many challenges in the face of this pandemic, from initiating our own laboratory-developed tests to securing PPE and testing supplies, and ensuring all shifts are covered around the clock with personnel,” Netto said. “We have had to be nimble to respond to our residents’ and fellows’ continuing education needs, for example, and to work out ways for our research faculty to continue their lab work wherever possible. Our colleagues have organized blood drives and encouraged participation in them to the point that critically low blood supply levels in the area have leveled off.”

One example of the department’s staff’s adapting to serve unmet needs is reconfiguring the department’s Roche COBAS 6800 machine — usually used for hepatitis and STD testing — now running high-throughput COVID-19 tests. This effort, under the direction of Craig Mackinnon, M.D., Ph.D., division director for Genomic Diagnostics and Bioinformatics, has resulted in more highly automated testing that requires less personnel and tech time to complete, with results reporting directly to the electronic medical record.

“If there is a silver lining in this, it is the acquisition of new information systems we can use to develop a huge database of all patients tested in the labs to identify trends for patient outcomes and treatments,” Mackinnon said.

Netto says the next step, in addition to faster turnaround times on COVID tests, is serology testing — offering the ability to detect COVID-19 specific antibodies in serum to test for prior exposure.

“The serology test is coming online this week,” Netto said. “Serology testing could also support convalescent serum therapy — using blood plasma from recovered COVID patients to treat critically ill COVID-19 patients.”

The work does not stop there, as more departmental faculty are submitting funding applications for more COVID-19 research. Leal was recently awarded a School of Medicine grant to optimize the current test assay and increase capacity fourfold, including the detection of other viruses such as influenza and RSV, “to speed the time to an accurate diagnosis for our patients and limit the need for unnecessary testing with expensive viral respiratory panels.”

Both Netto and DeMoss say they are grateful for how hard the teams at UAB are working.

“Our teams with the Department of Pathology and UAB Hospital Labs are extremely important during this pandemic,” DeMoss said. “They have moved mountains with our testing capabilities for patients, UAB faculty and staff, and we are getting more efficient with our testing with each passing day.”

At UAB, Netto holds the Robert and Ruth Anderson Endowed Chair.

For more information, visit uab.edu/coronavirus.

(Courtesy of UAB)

9 months ago

UAB top nurse reads letters of support from Birmingham children

(Adam Pope/UAB)

The support from the Birmingham community, the state of Alabama and beyond has been overwhelming for front line hospital workers battling the coronavirus pandemic at the University of Alabama at Birmingham.

UAB Hospital’s Chief Nursing Officer Terri Poe, RN, recently received letters and notes of support from children in the Birmingham area.

“We have maybe 25 notes from kids we don’t even know,” she said. “I think the support we have received from the community has been excellent. Everybody feels it.”

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This story originally appeared on the University of Alabama at Birmingham’s UAB News website.(Courtesy of Alabama NewsCenter)

10 months ago

UAB among first in the U.S. to offer clinical trial for the treatment of patients with severe COVID-19 using nitric oxide

(Pixabay, YHN)

The University of Alabama at Birmingham has been selected to begin enrolling patients in an international study assessing the use of inhaled nitric oxide (iNO) to improve outcomes for COVID-19 patients with severely damaged lungs.

Currently, there are no approved treatment options available against the SARS-CoV-2 virus, which causes COVID-19, although many medications are currently being tested to see if they may be effective. Acute respiratory distress syndrome, a severe form of lung failure, is the leading cause of death in COVID-19.

iNO has been used for the treatment of failing lungs, but it was also found to have antiviral properties against coronaviruses. The antiviral effect of iNO was tested and demonstrated during the 2002-2003 SARS pandemic, which was caused by a similar coronavirus called the SARS-CoV virus.

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When lungs are failing, some parts of the lungs receive air while some do not. iNO is a gas that improves the blood flow to those areas of the lung that are receiving air, boosting the amount of oxygen circulating in the blood stream. It also reduces the work of the right side of the heart, which is under extreme stress during conditions of lung failure, such as severe COVID-19 infection.

With the start of this trial, any COVID-19 patient who is admitted to UAB’s ICU and is breathing with the assistance of a ventilator may potentially qualify for the study.

“This trial will allow the sickest COVID-19 patients at UAB access to a rescue therapy that may have antiviral benefits in addition to improving the status of lungs,” said Vibhu Parcha, M.D., a research fellow with UAB’s Division of Cardiovascular Disease.

Pankaj Arora, M.D., assistant professor in the division, is spearheading UAB’s efforts in providing this treatment option to eligible COVID-19 patients. The mechanism of benefit of iNO could be the direct antiviral effect as shown in the SARS 2003 pandemic, modulation of oxidative stress, or improvement of the ventilation perfusion matching in the lungs, Arora says. His group plans to study the cardiovascular effects of high-dose inhaled NO in an ancillary effort to the primary clinical trial.

“In humans, nitric oxide is generated within the blood vessels and regulates blood pressure, and prevents formation of clots and also destroys potential toxins,” Arora said.

The UAB team says this pandemic has led to an extraordinary unifying response by the medical community, including ICU physicians, nurses, respiratory therapists, clinical trial specialists, reviewers and medical administrators, allowing for faster than normal approvals for potentially lifesaving research studies.

“The fact that we are able to get this trial started quickly was due to collaborations across specialties and fields of expertise at UAB with the common goal of providing the highest quality of scientifically proven care for our COVID-19 patients,” Arora said. “We are all trying to fight this together, and I hope, with our resilience, we shall overcome these difficult times.”

As the coronavirus pandemic grows each day, the medical community has been working tirelessly to help people infected with COVID-19. For up-to-date information about UAB and how to protect yourself, visit uab.edu/coronavirus.

(Courtesy of UAB)

10 months ago

Is it safe to order food delivery during COVID-19 outbreak? CDC, UAB experts say yes

(Phil Free/Alabama NewsCenter)

Feel free to order that pizza or call in for curbside pickup at your favorite local restaurant: The risk of contracting COVID-19 through food delivery or pickup – the packaging or the food itself – is low, according to leading health organizations and Jodie Dionne-Odom, M.D., assistant professor in the University of Alabama at Birmingham’s Division of Infectious Diseases.

Food delivery has been recommended as a simple way to maintain social-distancing practices during the global COVID-19 outbreak, because there is little risk of virus transmission through food itself, says Ian Williams, Ph.D., chief of the Outbreak Response and Prevention branch of the United States Centers for Disease Control and Prevention, which investigates food and waterborne illnesses.

The United States Food and Drug Administration and the United States Department of Agriculture concur; no organization has reported that COVID-19 can be transmitted by food or food packaging. The biggest risk of transmission, Williams says, is in exposure to individuals who are symptomatic.

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“There is no evidence out there, so far with [COVID-19], that it’s foodborne-driven or food service-driven,” Williams stated in a webinar. “This really is respiratory, person-to-person. At this point, there is no evidence really pointing us toward food [or] food service as ways that are driving the epidemic.”

Food packaging also poses little risk; Dionne-Odom says she encourages people to continue shopping for needed items, including food, via delivery services. Just remember to wash your hands frequently, she cautions.

“Packages will be coming from a number of hands, and you might not know the symptom status of everyone who touched it along the way,” Dionne-Odom said. “Wash your hands after opening and handling the package. That will kill the germs.”

To minimize the risk to households frequently utilizing curbside pickup services, Dionne-Odom recommends designating the same person to pick up the order each time.

“Ideally, this person would not be symptomatic, be under the age of 60 and have no chronic medical conditions,” she said. “It makes it simplest for them to have a procedure for each time they come and go – washing their hands carefully every time they enter and exit the home.”

For those who live in a walkable community, Dionne-Odom says walking to pick up takeout can be a healthy activity to prevent feeling stir-crazy and engage your body during periods of isolation.

“We want people not to go crazy sitting inside,” she said. “It’s OK to go outside and get fresh air. You always want to maintain that 6 feet of separation from others, but we encourage people to get outside for their mental health and for all the other reasons it’s good to get outside.”

For more information about COVID-19, visit UAB’s official resource page.

This story originally appeared on the University of Alabama at Birmingham’s UAB News website.

(Courtesy of Alabama NewsCenter)

10 months ago

UAB Pathology to increase COVID-19 testing by week’s end

(UAB/Contributed, YHN)

Researchers with the University of Alabama at Birmingham’s Department of Pathology are collaborating with Children’s of Alabama to increase the testing capability of COVID-19 for hospitals and health care facilities across Alabama.

Testing for COVID-19 has been limited in Alabama as more and more people are exposed to the virus, creating a strain on all health care workers.

Sixto Leal, M.D., Ph.D., assistant professor, UAB Pathology, is spearheading this effort.

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“This test should be available by the end of this week and will allow us to begin processing 100 tests per day,” Leal said. “We will be testing primarily priority in-patients at UAB Hospital so we can preserve negative pressure rooms. Within three to four weeks, we hope to have 800 tests per day.”

A new update from the CDC for UAB’s testing includes the ability to work directly with the Alabama Department of Public Health instead of having to wait for guidance from the FDA.

“Another thing we’re doing is working with diagnostic test companies on multiple platforms and multiple systems to increase capacity,” Leal said. “One of the issues we’re facing nationwide is that there is such a demand for reagents to do these diagnostic tests, and the reagents are not available. That’s why we’re going the LDT route, which is a laboratory developed test. Developing our own tests enables us to obtain the reagents to be able to perform the tests. So a lot of commercial manufacturers are ramping up their production, which makes tests available, and we’re working to bring up several of these here at UAB.”

All of these updates include providing microbiologically sound advice to keep lab staff safe while handling specimens, and help communicate to lab and medical staff specific details on processing specimens or interpreting diagnostic tests.

For more updates on COVID-19, visit uab.edu/coronavirus.

(Courtesy of UAB)

11 months ago

How to prepare yourself in the midst of a pandemic

(UAB/Contributed, YHN)

As COVID-19, also known as coronavirus, becomes more prevalent around the world, University of Alabama at Birmingham experts share tips to help you prepare yourself, your family and your home should the virus continue to gain momentum.

What is COVID-19?

Human coronaviruses are the second most common cause of colds and generally cause mild to moderate symptoms. Sometimes, coronaviruses that infect animals can evolve and become a new human coronavirus, as in the case of Severe Acute Respiratory Syndrome (SARS) in 2003 or the novel coronavirus, COVID-19, which first appeared in late 2019.

“This has become dangerous because this is a first-of-its-kind type of coronavirus, and all humans do not have immunity built up to fight it,” said Rachael Lee, M.D., UAB Medicine’s health care epidemiologist and assistant professor in the Division of Infectious Diseases.

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The Centers for Disease Control and Prevention (CDC) is closely monitoring the evolving epidemic of respiratory illness caused by the novel coronavirus, which was first identified in Wuhan, Hubei Province, China. To date, Chinese health officials have reported thousands of infections with the virus in China, as well as community spread in other locations such as South Korea, Italy and Iran.  To date, the United States has had a minimal number of cases. The CDC anticipates that the virus could spread and affect countries worldwide, including the United States.

Based on early reports of COVID-19, symptoms typically include fever, runny nose, headache, cough and a general feeling of being unwell; these are the same symptoms of the common flu virus.

If you begin to experience flu-like symptoms, UAB doctors recommend seeking medical care as soon as possible.

Wash your hands

Caroline Cartledge, a nurse practitioner with UAB Student Health Services, details the right way to make sure your hands are as clean as possible.

“Wash your hands as much as you can,” she said. “We always recommend handwashing before you eat anything before you make food for other people and after you use the restroom. I wash my hands anytime I touch a doorknob; if there is hand-sanitizer around, I always use it.

People touch their faces more often than they realize. Every time you touch a door handle and then scratch your nose, you are susceptible to contracting viruses.”

Cartledge recommends lathering your hands with soap and water for at least 20 seconds.

“A good rule of thumb is to sing or hum ‘Happy Birthday’ to yourself twice,” she said.

Traveling and more

Lee says to follow the CDC and local health care authorities’ guidance regarding travel to areas with active disease. She recommends using common sense to be safe and careful in traveling.

“As with any respiratory virus, the main recommendations hold true with the novel coronavirus,” Lee said. “Wash your hands, cover your cough with your arm, and stay home if you feel sick. Wearing surgical masks out in public is not recommended, as brief exposure to the virus in public is unlikely to make a person sick. Most cases have occurred when there has been prolonged contact, such as with health care professionals or family members serving as a caregiver. Use of masks is recommended for health care professionals, caregivers and those with disease symptoms.”

Lee adds that, in the United States, we have seen very few cases of COVID-19. However, we are still seeing a large number of influenza cases that are causing many hospitalizations across the United States.

“It’s important at this time to get to your flu shot if you have not already done so,” Lee said.

She also suggests that, if you have symptoms and need to see a health care professional, call ahead to your health care provider, so that they can take appropriate precautions to treat you and safeguard themselves and others in the clinic or hospital when you arrive.

Building immunity

While washing your hands is always recommended, Jessica Grayson, M.D., assistant professor with the UAB Department of Otolaryngology, says certain foods and supplements can help boost your immune system, potentially protecting your body from germs.

“Foods that contain indole-3-carbinols have been found to reduce the number of viral infections — while this hasn’t been specifically tested in coronaviruses, the prevention of any viral illnesses that may weaken your immune system is and will be important,” Grayson said. “These foods include leafy greens like kale, spinach, collard greens, turnip greens, mustard greens, etc. They can be cooked or raw.”

Grayson adds that elderberry has certain compounds that have been approved by the FDA for use in flavoring of food.

“There are many studies on the antiviral and antimicrobial activity of elderberry,” Grayson said. “It has been shown in some studies to bind to some subtypes of the flu virus to prevent cell entry. However, there are still more studies needed to confirm whether this is true substantial benefit.”

You can also boost your immune system by maintaining a healthy lifestyle, says Lee. Eat a balanced diet, get plenty of rest, and avoid stress.

Grayson also says there is no data to support that increased Vitamin C helps prevent or shorten viral illnesses. In fact, studies looking at this have shown no benefit. Utilizing the leafy greens above in a smoothie can be an easy way to increase intake, but strictly drinking orange or pineapple juice does not have proof of benefit.

Protect your home and loved ones

Ian McKeag, M.D., a family and community medicine physician at UAB, says now is the time to disinfect and clean your home. Use isopropyl alcohol, or disinfecting wipes, to wipe down countertops and common areas.

“Keep the surfaces of your home clean, especially areas where you eat and spend the most time,” McKeag said. “Use soap and water to wash your hands after you touch contaminated areas, such as doorknobs, toilet and faucet handles, and any cooking items. If you do not have access to soap and water, use hand-sanitizer.”

McKeag adds that it is also a good idea to avoid shaking hands with others right now. If you do, wash your hands or use sanitizer right away, especially before touching your face.

Grayson says you should limit the amount of time spent in public places and avoid people who are sick, including those who are coughing or presenting symptoms.

“If you have a fever or other symptoms, stay home,” Grayson said. “If your children have a fever, do not send them to school. Consider working from home if your workplace allows it.”

Finally, she recommends planning ahead for your daily medications.

“Be sure that you have plenty of the medicines that you routinely take so that if ill you can avoid going out in public to retrieve these things,” Grayson said. “In the case of a pandemic or major outbreak in the U.S., it is a good idea to stock up on non-perishable foods should your community be quarantined.”

For more information about COVID-19, visit UAB’s official resource page.

(Courtesy of UAB)

1 year ago

UAB doctor advises how to keep flu germs from spreading at home

(UAB/Contributed)

Flu season can take its toll on your health, but one way to fight the virus is to stop the spread of germs at home. University of Alabama at Birmingham Assistant Professor Neena Xavier, M.D., shares these tips to help you and your family strengthen your defenses this flu season.

What are some of the best ways to germ-proof your home?

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You cannot really germ-proof your home, but you can clean and disinfect things to improve your chances of preventing the flu.

First, cleaning surfaces using soap and water and disinfectant sprays can decrease the number of germs and lower the chances of spreading them around.

Second, disinfecting commonly touched surfaces can kill germs and help lower the chances of getting sick. Avoid touching used tissues or other waste when emptying your trash, and wash your hands afterward to avoid getting those germs.

What are the biggest germ culprits in your home, and how should you disinfect them? 

Commonly touched surfaces such as countertops, doorknobs, computer keyboards, toys, phones and faucet handles are major culprits for carrying germs. Make sure the product you are using is EPA-registered to both clean (remove germs) and disinfect (kill germs). Read the directions on the product on how to use it because different chemicals have different procedures on how many wipes are needed or how long to keep the surface wet – usually three to five minutes.

How can a humidifier or air filter help keep your home flu-free? 

Dry air can cause scratchy throats, congestion and nosebleeds. While there are no scientific guidelines about the use of humidifiers to prevent flu, the germs may be able to survive in the drier air conditions. So the thought is that if you keep the humidity level up in a room, the virus is less likely to survive. Just be careful of warm mist humidifiers because, if not cleaned properly, they can grow bacteria and mold, which can cause serious illness.

How often should you wash sheets and towels during flu season? 

Most studies have shown that the flu virus can live on surfaces for up to 48 hours. However, it is not necessary to wash surfaces every day. Using harsh chemicals to wipe every surface often can irritate the eyes, nose, throat and skin and aggravate asthma if you suffer from it, so you may cause more harm than good. In general, the important thing is to make sure you wash regularly and do not share towels or sheets with those who are sick without washing them first.

Remember, the virus is killed by hot temperatures, so if you do clean your sheets and towels, use the hot temperature setting instead of warm.

What are the best tips to protect yourself if someone in your house already has the flu?

If it is possible, choose a bathroom for the sick person to use and their own bedroom to sleep in. Plan to clean these rooms daily. Have some disposable face masks at the house for other members, especially those who have other medical conditions that make them more likely to get sick.

Xavier is an assistant professor in the Department of Clinical and Diagnostic Sciences and faculty member with the Physician Assistant Studies program in the UAB School of Health Professions.

For more information on prevention, symptoms and vaccines, visit uab.edu/flu.
(Courtesy Alabama NewsCenter)

 

 

1 year ago

Three siblings share cancer diagnosis caused by rare genetic mutation

The Perkins family got a new lease on life when siblings Kevin, Kiala and Keaira had thyroid surgery at UAB. The children had a rare genetic condition that causes thyroid cancer because of a mutation on the RET gene. (Adam Pope/UAB)

At first glance, Kevin, Kiala and Keaira Perkins may seem like typical 17-, 14- and 11-year-old children, respectively. But, after getting to know them, you might be shocked to find out that all three have suffered from thyroid cancer.

The siblings, from Madison, Alabama, all suffer from a rare genetic condition called multiple endocrine neoplasia (MEN2A), a rare, hereditary condition occurring in roughly one in 35,000 people in the United States. It is caused by a mutation in the RET gene, which provides instruction for producing a protein that is involved in cell signaling and is needed for the normal development of several kinds of nerve cells.

“In December 2018, Kevin was tested for MEN2A by his pediatrician, and later received a call from UAB and Dr. Herb Chen,” said LaToya Wade, the mother of Kevin, Kiala and Keaira. “Dr. Chen said, ‘we need you here as soon as possible,’ and soon after we met with Dr. Chen, we scheduled surgery for Kevin.”

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Soon after Kevin’s surgery to remove his thyroid, Kiala and Keaira underwent the same testing. The result: Both tested positive for MEN2A.

People with MEN2A have one functioning RET gene and one that triggers cells to divide abnormally, causing tumors in the endocrine system and other tissues. MEN2A, identified in the children’s father and aunt by the aforementioned blood test, leads to medullary cancer of the thyroid, pheochromocytoma – tumors in the adrenal gland – and hyperparathyroidism, which causes excessive calcium in the blood and can lead to kidney damage. If one parent has MEN2A, the children have a 50 percent chance of inheriting the same mutation.

“Thyroid cancers, including medullary thyroid cancer, start out so small that you don’t notice them,” Chen said. “With genetic testing in patients with MEN2A, if the child tests positive, I can tell a parent there is a 100 percent chance their child will develop thyroid cancer.  Importantly, we can do surgery ahead of time to remove the thyroid before the cancer develops.”

Chen, chair of the UAB Department of Surgery, says cases like the Perkins’ are an example of how genetic testing can diagnose someone’s risk and eventual prevention of cancer by doing prophylactic surgery (an operation before the cancer develops in the organ).

To treat the Perkins family, Chen removed the thyroids of all three children in addition to Kiala’s parathyroid. They will have to take medications for the rest of their lives to make up the hormones their body loses after removing the thyroid glands.

It is a small sacrifice to prevent a larger problem.

“We were fortunate to treat the Perkins family while their cancers were very, very small,” Chen said.

Wade said finding out a loved one has cancer is always scary, let alone three of her children. However, she knew her family would be in the best of care with Chen and Nurse Practitioner Kelly Lovell.

“For me, this was a trying process,” Wade said. “When your kids have surgery, you never know what’s going to happen. I just didn’t know what was going to happen. I didn’t want to tell them I was nervous, so I had my moments alone, and I just kept praying. My mind was all over the place, but now they are doing well. They’re on top of their game.”

Chen agreed the siblings have a bright future ahead.

Kevin, a senior in high school, plans to study engineering in college, while Kiala and Keaira want to become an actress and a doctor, respectively.

Wade said she hopes her family’s story will help others seek genetic testing, so doctors can prevent more cases of thyroid cancer from developing.

Chen, who also serves as a senior scientist with the O’Neal Comprehensive Cancer Center at UAB, echoed her wishes.

“We’re taking a cancer that could cause harm and completely removing it before it starts,” he said. “That’s why it is so important that people hear about this condition.”

If you would like to learn more about this rare genetic condition, the UAB Endocrine/Neuroendocrine Neoplasia Program of the O’Neal Comprehensive Cancer Center and the Department of Surgery in conjunction with AMENSupport Foundation will host a multiple endocrine neoplasia patient conference Saturday, Nov. 16.

For more information, visit the Department of Surgery’s website.

This story originally appeared on the University of Alabama at Birmingham’s UAB News website.

(Courtesy of Alabama NewsCenter)

1 year ago

State of addiction: How UAB is making an impact on the opioid crisis

(UAB/Contributed)

The numbers – and the heartbreaking stories contained within them – are staggering.

According to the Centers for Disease Control and Prevention, two out of three drug overdose deaths involve an opioid. Overdose deaths from opioids, including prescription opioids, heroin and synthetic opioids like fentanyl, have increased almost sixfold since 1999. Opioid-involved overdoses killed more than 47,000 people in 2017, and 36 percent of those deaths involved prescription opioids.

Alabama is not immune to the consequences of opioid use. In 2017, the state had the highest overall opioid prescribing rate.

Why is that, and what can be done to make sure people are cared for while not harming them at the same time?

The University of Alabama at Birmingham has made significant contributions in the battle against opioids in the research field and at the bedside, all in an attempt to answer those questions and, ultimately, save more lives.

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How did we get here?

Dr. Stefan Kertesz, an addiction scholar and professor in UAB’s Division of Preventive Medicine, has been a vocal leader in the fight against addiction. He has been an influential national voice by demanding opioid prescribing policies be made clearer, on behalf of patients and the doctors prescribing them.

Kertesz said there is no single person or entity to blame for the meteoric rise in opioid-related deaths, but physicians have been part of the problem.

“Part of how we got here certainly reflects a change in medical practice,” Kertesz said. “And that change was that we prescribed a lot more, and we created a market for people in pain – both with a history and with no history of addiction – to have more access to opioids.”

According to the CDC, after a steady increase in the overall national opioid prescribing rate beginning in 2006, the total number of prescriptions dispensed peaked in 2012 at more than 255 million. The prescribing rate was 81.3 prescriptions per 100 people. Although the overall rate has decreased in the past few years, in a number of U.S. counties enough opioid prescriptions were dispensed for every person to have one.

Because of the high volume of patients with opioid-related addictions, UAB saw an opportunity to strengthen its care of these patients. One route it took to enhance care was to create the Addiction Scholars Program.

The nation’s ongoing opioid crisis created a situation in which medical staff in virtually every unit of the hospital can, at some point, expect to find themselves treating patients who are abusing opioids and other drugs.

Created in 2017, UAB’s Addiction Scholars Program gives health care providers training and insight on opioid addiction. The initiative recruits hospital staff – physicians, nurses, therapists, social workers and more – who undergo a 15-month curriculum taught by UAB experts in addiction medicine. The goals are to better prepare staff for the challenges patients face with opioid addiction and to find better ways to provide the appropriate care to this patient population.

“Most physicians don’t receive formal training in addiction management,” said Dr. Eddie Mathews, a hospitalist and one of the first scholars. “Yet there is a clear need for enhanced education for all medical professionals. We need to learn about the disease process in addiction and learn how we can better treat these patients, both for their opioid use and for any underlying or concurrent medical issues.”

At UAB’s School of Dentistry, professors are taking the lead in the dental field to combat the growing opioid epidemic in hope that their measures will be translated into other practices and fields across the state and country.

“The public health crisis we are dealing with stems from many roots, ranging from easy access to prescription medication and the quantity in which medication is prescribed, to the inability of physicians to set realistic expectations with patients about pain,” said Dr. Nico Geurs, chairman of UAB’s Department of Periodontology. “As dentists, we’re facing a watershed time when patients have a list of requests for pain medications that they think they need and expect to receive, none of which are in line with reality. Pain management with opioids has been normalized in American culture, and it’s rapidly spiraling out of control.”

UAB dental students study pain, anxiety and pharmacology, and they learn to care for people in active addiction and recovery. Their training emphasizes best practices in pain management – such as dispensing small medication doses – and the complex factors to consider when prescribing. Two examples: UAB dentists take thorough patient histories, noting requests for specific painkillers, a possible sign of abuse. They check the Alabama Prescription Drug Monitoring Programdatabase to see who already has received potentially addictive medications.

“Closing the loop isn’t easy, and this is new territory for all of us,” Geurs said. “For the School of Dentistry to be in a position where we can help alter the trajectory of this epidemic is one that we take with great responsibility, and we hope public and clinical education will help protect others moving forward.”

More students at UAB’s School of Nursing use its state-of-the-art Nursing Competency Suites to train students to treat infants born to mothers who used opioids during pregnancy. Students are trained to treat these infants through an NICU simulation lab, which includes an NICU infant manikin that is able to mimic symptoms of a baby suffering from opioid withdrawal.

Strengthening commitment to care

Opioids can affect many different people – chronic pain patients, pregnant mothers – and often lead to other forms of addiction.

UAB Medicine’s Addiction Recovery Program offers an individualized approach to the assessment and treatment of alcohol and substance abuse. Staff includes licensed and certified counselors and social workers who work with patients individually and in groups to provide thoughtful, caring treatment for addiction.

Recovery is possible, Dr. Cayce Paddock emphasizes.

“Some of the most psychologically and emotionally healthy people I know are in recovery from a substance abuse disorder,” said Paddock, who leads the program alongside Dr. Peter Lane. “When I see someone in active addiction, I see them at their lowest. But they can live and thrive. When I meet people in active addiction, I see them as they can be, not as they are in that moment.”

Unfortunately, opioid addiction can affect the most vulnerable as well.

The National Institutes of Health found that a baby is born suffering from opioid withdrawal every 15 minutes in the United States. Use of opioids during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome, or neonatal opioid withdrawal syndrome (NAS/NOWS).

The Comprehensive Addiction Pregnancy Program, led by Dr. Lorie Harper and UAB’s Maternal-Fetal Medicine team, provides an environment in which women suffering substance-use disorders during pregnancy and postpartum can experience recovery through comprehensive, peer-supported, multidisciplinary care. CAPP’s group prenatal care area provides a full complement of obstetric addiction therapy, including opioid replacement therapy, sub-specialty pediatric follow-up, care coordination, social services, peer recovery support and in-home parenting education.

In April 2019, CAPP celebrated its first year of outpatient treatment, graduating more than 40 women through the program from pregnancy to postpartum support. The program is growing tremendously and serves a critical role in providing necessary care and support to addicted mothers.

Alabama hospital emergency departments have become all too familiar with patients suffering from opioid overdose. According to the Centers for Disease Control and Prevention, Jefferson County alone had 98 deaths from heroin and 104 from fentanyl use in 2017.

“Emergency departments are the tip of the spear where societal problems meet health care,” said Dr. Erik Hess, vice chairman for research for the UAB Department of Emergency Medicine. “The nation’s opioid epidemic plays out every day in our emergency departments.”

The department has launched a new initiative to help patients with opioid use disorders get appropriate therapy and referral for further assistance in an effort to put a dent in the epidemic.

The program, called the ED MAT, or Medication Assisted Treatment Protocol, is funded by a $1.5 million grant from the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services.

The program has several components. ED MAT protocols include the use of buprenorphine/naloxone in the ED to treat the symptoms of opioid withdrawal and to decrease cravings. It is followed by a short-term prescription of buprenorphine/naloxone, if appropriate, and a take-home naloxone kit. Buprenorphine/naloxone, also known as Suboxone, is used to treat opioid use disorder. It can reduce withdrawal symptoms for 24 hours. Patients are connected with a peer navigator while in the emergency department. The navigator assists patients with referrals to follow treatment through the Recovery Resource Center of Jefferson County at Cooper Green Mercy Services.

Prevention through technology

Monitoring the latest tactics in drug sales used online to mask the activity, such as new street names for drugs, is the focus of a partnership between the UAB Computer Forensics Research Lab and Facebook. UAB works closely with Facebook’s Community Operations team to flag content that may violate its Community Standards for illicit drug sales.

“Our partnership with Facebook has grown from identifying spam to anti-terrorism work and now combating drug sales online,” said Gary Warner, director of research in computer forensics in UAB’s College of Arts and Sciences. “Our students receive hands-on learning in monitoring online communities to identify and develop a database of terms attempted by bad actors to skirt detection. These key terms will be used within the coalition to fight drug sales across multiple platforms.”

With the expertise based at UAB, CFRL shares insights from its research with Facebook and from what is monitored elsewhere on the web.

The CFRL works closely with the UAB Forensics Science Program led by Elizabeth Gardner, Ph.D., in the Department of Criminal Justice to study emerging drugs of abuse, and counterfeit and illicit drugs purchased online. The interdisciplinary partnership combines the online criminal expertise of CFRL and Gardner’s ability to perform drug analysis, along with her and her students’ chemical expertise, to assist a variety of law enforcement and government agencies.

In working with Gardner and her chemists, the CFRL team now has more than 350 search terms for synonyms and analogues of fentanyl. A combination of pairing these keywords with phrases about the purchase and shipping of drugs, combined with a complex “white list” of academic, medical and journalistic mentions of drugs, helps the team quickly target drug sales sites while avoiding many unhelpful sites.

Future of care

Unfortunately, experts agree that opioid-related issues seem to be here to stay – at least for the time being. With that understanding, UAB has commissioned an Opioid Stewardship Committee. A kickoff meeting will take place this summer, when the committee of about 40 members will be present.

The committee’s mission and vision is to provide safe, effective and patient-centered pain management at UAB Medicine. It will create an organizational infrastructure that advocates for safe opioid prescribing while sustaining effective, patient-centered pain management throughout UAB Medicine through engagement and education of patients, clinicians and administrators.

“The opioid crisis has had a significant detrimental impact on our community,” said Dr. Juhan Paiste, an associate professor of anesthesiology who will chair the Opioid Stewardship Committee. “With the Opioid Stewardship Program, we hope to address the complex issues and pain management needs that our patients have, and ensure our providers have access to the most innovative, efficient, evidence-based and safe-practice guidelines. We know that, once we have our resources and best practices in place, we can make a positive difference for everyone.”

UAB’s commitment to lead in the delivery of the highest-quality patient-centered integrative care is clearly defined in the university’s strategic plan, Forging the Future. Its desire to engage with the community and expand access to resources is a key focus, as is improving the welfare of our society.

The knowledge and will to fight the opioid epidemic from all angles – from the medical care and services it provides to aiding law enforcement and social media giants as they work to identify, squeeze and dismantle online drug dealers —  is why UAB is best positioned to combat the far-reaching opioid crisis.

“UAB is a national leader in research, clinical care and medical education,” said Jordan Demoss, UAB Medicine vice president of Clinical Operations. “We have a responsibility to find solutions to this problem. Our goal is to truly implement a multidisciplinary, integrated approach to battling this epidemic.”

This story originally appeared on the University of Alabama at Birmingham’s UAB News website.

(Courtesy Alabama NewsCenter)

2 years ago

UAB researchers discover new biomarker for age-related macular degeneration

(Contributed/Alabama NewsCenter)

Researchers from the University of Alabama at Birmingham Department of Ophthalmology and Visual Sciences, along with collaborators from the University of Iowa, have discovered a genetic biomarker that is associated with age-related macular degeneration and delayed rod-mediated dark adaptation – the first visual function for incident AMD in older adults with normal macular health and early AMD.

According to the Centers for Disease Control and Prevention, AMD is a major cause of blindness worldwide and is the leading cause of vision loss and blindness for Americans age 65 years and older.

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Professors Cynthia Owsley, Ph.D., and Christine Curcio, Ph.D., say there are no current proven strategies for preventing AMD or stopping its progression early in the disease when sight could be saved. Two of the strongest genetic associations for age-related macular degeneration are common polymorphisms – variants in DNA sequence – at chromosome 1 (CFH) and chromosome 10 (ARMS2).

“We have previously shown that delayed rod-mediated dark adaptation is the first functional risk factor for early AMD,” said Owsley, the Nathan E. Miles Chair of Ophthalmology. “Delayed dark adaptation means it takes these individuals much longer to adapt to a dark environment – for example, after entering a darkened movie theater – than other individuals. This was important, because vision in bright light was known to be relatively preserved late into the disease. Night vision is affected much earlier. ”

In other words, older adults with delayed dark adaptation have a heightened risk for developing AMD within the next few years.

In the recently published study, Owsley and Curcio, with collaborators Robert Mullins and Edwin Stone of the University of Iowa, established that older adults with delayed dark adaptation are also more likely to have these high-risk genetic polymorphisms at chromosome 1 and chromosome 10.

“This finding was the first genotype-functional phenotype association found in AMD research,” Owsley said. “What we find particularly exciting is that the ARMS2 genotype-phenotype association emerges even at pre-clinical stages of AMD – that is, in older adults who do not yet have AMD. Being able to assess risk at such an early stage could lead to new preventive measures.”

Owsley says the ARMS2 gene is poorly understood from a biological standpoint and is also challenging to study because it is not expressed in adults.

“However, our study suggests that making ARMS2 a research priority will lead to new ways of tackling AMD and developing treatments to prevent this disabling disease,” she said.

Funding for this research was provided by National Institutes of Health grants, the Dorsett Davis Discovery Fund, the National Center for Advanced Translational Sciences of NIH, the Alfreda J. Schueler Trust, the EyeSight Foundation of AlabamaResearch to Prevent Blindness and the Macula Foundation.

(Courtesy of Alabama NewsCenter)

3 years ago

Alabama cancer survivor Valerie Powell: ‘Career move saved my life’

(Adam Pope/UAB)

After an eight-year struggle to figure out why a lump formed under her jaw, to say Valerie Powell believes all things work together for good is an understatement.

In 2009, Powell, program coordinator in the University of Alabama at Birmingham’s Department of Radiation Oncology, noticed a tiny nodule near the hook of her jaw that had not been there before. She assumed it must be a side effect of the several Novocain shots she received at the dentist for a cavity filling. After calling her doctor, Powell received regular CT scans, which provided no further insight.

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After six years, Powell’s mother was diagnosed with breast cancer, which led to Powell’s wanting another CT scan for her nodule.

“I figured after Mom’s diagnosis and the fact this little nodule had obviously gotten angrier in size and tenderness that I should check on things again,” she said.

Her doctors determined that she had an extra piece in her parotid gland and advised her not to worry.

Things began to change for Powell after she landed her program coordinator job in UAB Radiation Oncology in March 2017. She started researching oncology protocols as part of her duties, and the first protocol she reviewed was a salivary gland tumor study, which persuaded her to try another CT scan from a different clinic, which also proved to be inconclusive. She also received an MRI, which showed the same results.

Powell knew something was wrong and demanded answers.

“I was pretty frustrated, so I emailed one of our radiation oncologists at UAB and explained that two doctors at a different local hospital were unable to figure out what it was,” she said. “I asked if he could take a look at my scans.”

Soon after, Powell found herself scheduling an appointment with Department of Otolaryngology Chair and Comprehensive Cancer Center Senior Scientist William Carroll, M.D. The nodule in question was diagnosed as pleomorphic adenoma – a common benign salivary gland tumor.

“We scheduled surgery to remove the tumor because Dr. Carroll said he would remove it no matter what if I were his family member,” she said. “From the moment I met Dr. Carroll, he did feel like family. He’s always been patient and understanding, and he’s always done his absolute best to make sure I left his office confident and comfortable with the care I was receiving, and I would say that that’s hard to find.”

After the tumor was removed and pathology tests returned, it was determined that the tumor wasn’t actually benign; it was malignant.

“I was flooded with questions in my head like ‘Why did a CT, an MRI and a needle biopsy all confirm that my tumor was benign when it was in fact cancerous,’” Powell said. “Why was this happening to me at 28 when I’ve barely been married two and a half years, and why had no one paid more attention to this knot in my neck for the last seven years since it had shown up?”

The more she thought about it, Powell says, her faith reassured her that things worked out the way they were supposed to.

“I was supposed to go into surgery knowing it was benign because my little heart couldn’t have handled going into surgery knowing that I had let something dangerous live inside of me for that long,” she said. “God knew I needed the excitement of getting it out to carry me into that operating room with peace and a feeling of security.”

In September 2017, Powell began seeing Sharon Spencer, M.D., professor in the Department of Radiation Oncology and senior scientist with the Comprehensive Cancer Center, for her radiation treatments. It was a familiar setting for Powell since she walked the path every day to her office, which resides just a few steps from patient care areas. She worked closely with Spencer in the months leading up to her diagnosis and treatment.

“This was kind of a neat plot twist in the workplace because I showed up to see Dr. Spencer as a patient instead of needing her signature,” Powell said.

After six weeks of daily radiation, Powell’s co-workers threw her a party to celebrate her final day of treatment.

“When I saw 50-plus people crammed in our break room yelling congrats at me, I lost it,” Powell said. “People from every single department – physicians, residents, billing, check-in, dosimetry, therapy, social work, administration and physics. They had all come for me, and right in the middle was my precious husband, K.T., my parents and my brother.”

Powell credits many people – at work and at home – who helped dry her tears, listened to her worries, and saw how the effects of radiation affected her physically and mentally. She says it was a hard road, but it was exactly where she was supposed to be.

“This was the road that led me to the career I never knew I needed,” she said, “and the career move that saved my life.”

Powell hopes to empower cancer patients and survivors through her blog where she documented her treatment and recovery. Click here to follow her journey.

(Courtesy of Alabama NewsCenter)

3 years ago

Bilateral lung transplant gives Montgomery teen chance to graduate, better future

(UAB)

Quintarius Daniels has had a hard road to travel in his 17 years of life, but thanks to University of Alabama at Birmingham School of Medicine surgeons, he now has a bright and less complicated future ahead.

On Oct. 17, 2017, Daniels, a Montgomery, Alabama, native, had a bilateral lung transplant at UAB Hospital after years of battling pulmonary fibrosis, a disease that had ravaged his lungs and compromised their function. On May 18, Daniels walked across the stage at Brewbaker Technology Magnet High School, having earned his high school diploma – not to mention ditching his oxygen tank and being crowned prom king in the past seven months.

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“I’m so excited to be where I am today,” Daniels said. “Before I had my transplant, things were hard, because I couldn’t do things other kids could do.”

Daniels was diagnosed with pulmonary fibrosis as a child. Pulmonary fibrosis is a scarring of the lung tissue that causes permanent damage to the lungs. As the scar tissue builds up and thickens, it prevents the lungs from transferring oxygen to the blood supply and diminishes the supply of healthy, oxygen-infused blood to the heart, brain and other organs.

The reduced lung function makes it increasingly hard to breathe. While the condition may develop slowly over time, many patients diagnosed die within the first three to four years following diagnosis. There is no cure for pulmonary fibrosis, but certain medicines and therapies can help manage the disease.

Lashunda Harris, Daniels’ mom, noticed he was very sick one morning when he was about 2 years old. She quickly rushed him to the hospital, and he was later transferred to Children’s of Alabama, where he was diagnosed. For the past 15 years, Daniels has lived with an oxygen tank, which can hinder a child looking for a normal life.

“He was very limited as a child,” Harris said. “It was hard for him during P.E. at school to be able to do things every other kid could.”

In October 2017, Harris arrived at Brewbaker Tech to pick up Daniels from school. When she arrived, the school nurse brought him to the car in a wheelchair, which was unusual.

“The nurse said he wasn’t feeling good and his chest was hurting,” she said. “We went straight to Children’s.”

After a week’s stay at Children’s, Daniels was transferred to the cardiac intensive care unit at UAB Hospital. It was there they met Charles W. Hoopes, M.D., director of Lung Transplantation in the Division of Cardiothoracic Surgery, who told them that Daniels had been placed on the waiting list to receive a lung transplant.

After more than a week on a temporary mechanical support system to help his other organs rest and recover, and five days of being on the list, Daniels received a double lung, or bilateral, transplant.

“Dr. Hoopes is a wonderful person,” Harris said. “He’s like another parent.”

Daniels says he was excited – and maybe a little scared – for the transplant, but he knew that it would mean things might start to be a little easier for him.

“I was excited and scared because I didn’t know how it would feel to have a new set of lungs,” Daniels said.

After the transplant, Harris says, Daniels is much more of a free spirit. This spring, he was able to run for the first time and often races with his sister. Daniels was also crowned his high school’s prom king, and he’s been able to enjoy time with his friends without having to worry about an oxygen tank.

“I’m very happy that I can live a more normal life as a teenager,” he said. “After the transplant, I’m now able to do more.”

Daniels was thrilled to walk across the stage without the cumbersome oxygen tank to receive his high school diploma. He plans to enroll with the University of Phoenixand later become a video game designer.

“I’ve cried a lot since this transplant,” Harris said. “They’ve been happy tears. We still have a long way to go, but I am so happy he made it through.”

(Courtesy of Alabama NewsCenter)

3 years ago

‘A lucky one,’ UAB patient is well after oropharyngeal cancer treatment

(J. Walker)

May 2016 will be a time that Jan Walker will never forget.
Walker, a retired administrative assistant to the superintendent of Boaz City Schools, was getting ready for her regular doctor visit and noticed a lump on her neck. Her primary care physician examined it and determined it was a simple swollen lymph node. Two months later, she began to lose feeling on the right side of her throat and noticed the lump had increased in size.

After seeing other doctors for multiple opinions, she was sent to UAB Hospital, where she met with Department of Otolaryngology Assistant Professor Benjamin Greene, M.D., and found out something she had feared – it was cancer: oropharyngeal cancer, to be precise.

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“I was really upset,” Walker said. “My mom lost her battle with breast cancer, and this just really scared me. The first initial shock of being diagnosed made me think I was going to die, but I’m one of the lucky ones.”

According to Greene, oropharyngeal cancer – the oropharynx includes the tonsils and base of tongue – is a fairly uncommon cancer in general. In non-smokers, in these particular areas, the cancer is usually caused by HPV. The Centers for Disease Control and Prevention reports that about 3,200 cases of oropharyngeal cancers were found in women last year and about 13,000 in men in the United States. Walker did not smoke or drink alcohol, which put her in a rare group when she received her diagnosis.

“In general, the five-year survival rate of oropharyngeal cancer has been less than 50 percent,” Greene said. “Of course, this depends on stage at the time of diagnosis; however, we are finding that people who do not smoke or drink heavily do much better. In people who have cancer caused by HPV, the five-year survival rates can be 80-90 percent.”

After receiving her diagnosis, Walker, a Glencoe, Alabama, resident, began her treatment plan in September 2016 and included 35 radiation treatments and five chemotherapy treatments. Doctors also had to put in a port and feeding tube because the radiation made Walker’s throat irritable. Her patient navigators helped set appointments with UAB speech therapists and nutritionists so she could learn how to cope with her new way of life during treatment.

“I had a feeding tube – which probably was the worst part about the treatment – but the doctors told me to be conscious about swallowing so I wouldn’t lose muscle control,” Walker said.

Greene says radiation and chemotherapy for the head and neck can be very hard on people.

“All treatments for this type of cancer can be potentially disfiguring and debilitating,” he said. “It can affect the way we eat, the way we speak and the way we look, as well as our general quality of life.”

After five months of treatment and multiple subsequent follow-up visits, Walker received the news that she was cancer-free in March 2018. She will still have to see her UAB physicians every three months, but she has a new outlook on life and on what could have been a completely disheartening experience.

“This has changed my outlook on life tremendously,” she said. “It has made me closer with God, and I realize now that we’re not promised tomorrow. It was tough on my husband, Tolly, and two sons; but we got through it. We’re much closer as a family.”

Greene says the most important thing people can do to prevent these types of cancers is to quit smoking. Even though HPV is causing more head and neck cancers, smoking is still the No. 1 cause of these diseases. Greene also says it is very important that people go to their doctors whenever they have a sore throat or hoarseness that won’t go away.

“Cancers of the throat can masquerade as many things, such as ear pain, sore throat, hoarse voice, difficulty swallowing, coughing up blood or loose teeth,” Greene said. “Anything that is concerning should prompt a visit to a dentist, primary care doctor or otolaryngologist. It is extremely important to note that any enlarged lymph node or enlarged gland in a person over 40 is not normal and should be examined immediately. In general, people who have their head and neck cancers diagnosed early do much better in the long run and often need less-aggressive treatment.”

The UAB Department of Otolaryngology stands among the nation’s leaders in its field. Physicians provide advanced care across the spectrum of head and neck disorders with surgeons practicing in six areas of specialty. For more information, visit www.uab.edu/medicine/otolaryngology.

(Courtesy of Alabama NewsCenter)