Neurology

Project Title: Disparity of care in Neurofibromatosis Syndrome across Florida

Faculty Mentor’s Name: Dr. Hans Shuhaiber
Phone: 312-286-1059
Email: hans.shuhaiber@neurology.ufl.edu

Research Project Description:

Eurofibromatosis type 1 is a condition characterized by changes in skin coloring (pigmentation) and the growth of tumors along nerves in the skin, brain, and other parts of the body. The signs and symptoms of this condition vary widely among affected people. Beginning in early childhood, almost all people with neurofibromatosis type 1 have multiple café-au-lait spots, which are flat patches on the skin that are darker than the surrounding area. These spots increase in size and number as the individual grows older. Freckles in the underarms and groin typically develop later in childhood. Most adults with neurofibromatosis type 1 develop neurofibromas, which are noncancerous (benign) tumors that are usually located on or just under the skin. These tumors may also occur in nerves near the spinal cord or along nerves elsewhere in the body. Some people with neurofibromatosis type 1 develop cancerous tumors that grow along nerves. These tumors, which usually develop in adolescence or adulthood, are called malignant peripheral nerve sheath tumors. People with neurofibromatosis type 1 also have an increased risk of developing other cancers, including brain tumors and cancer of blood-forming tissue. At UF Neurofibromatosis Care center we care for 100 patient with genetic disease. Study looks at Genotype- Phenotype correlation and complexity of clinical care across patient variable age population.

Entry Date: October 10, 2019

Project Title: HANDEDNESS: IS IT RIGHT TO BE UP AND CLOSE?

Faculty Mentor’s Name: Dr. Kenneth Heilman
Phone: 352-514-4580 (cell)
Email: heilman@neurology.ufl.edu

Research Project Description:

The hand that a person selects to use, position and perform certain activities reflects the hemispheric dominance for mediating that activity. Although there have been many studies examining the relationships between hand preference strength, speed, dexterity-deftness and action programming, there has been little research on arm position in relation to the body. In this research program, we plan to perform 3 studies in an attempt to better understand arm posture. In Study 1, we explore whether their is a propensity for the right hand to held higher than the left. The goal of Study 2 is to learn if 1) right handed movements into right hemispace move upward more than right handed movements toward left hemispace; 2) left handed movement also elevate as they move to right hemispace, and; 3) if there are differences between the two hands. Study 3 will attempt to learn if the right hand likes to be closer to the body than the left hand.

This information could be useful in a clinical setting in explaining or identifying the underlying nature of certain types of movement action disorders (apraxia).

Entry Date: October 10, 2019

Project Title:Cardiac Arrest Survivors Database

Faculty Mentor’s Name:Dr. Carolina Maciel
Phone:9173552504
Email: carolina.maciel@neurology.ufl.edu

Research Project Description:

Multicenter International observational study. The objective of this study is to characterize the impact of withdrawal of life sustaining therapies on hypoxic-ischemic brain injury outcomes and identify tools that retain acceptable prediction accuracy to be incorporated in optimized multimodal neuroprognostication models. RedCAP database will be used.

Entry Date:November 27, 2019

Project Title: Integration of IntraOperative data with Preoperative data for improved Postoperative Sepsis Risk prediction

Faculty Mentor’s Name: Dr. Azra Bihorac
Phone: (352) 273-9009
Email: abihorac@ufl.edu

Research Project Description:

The project aims at developing prediction models to help study patient risk scores for postoperative sepsis complication given preoperative medical history and intraoperative EMR responses. Help will be required for literature review regarding sepsis phenotyping, feature importance discussion, result discussion, and problem statement definition in clinical views.

Entry Date: January 15, 2020

Project Title: Clinical phenotypes for AKI using clustering of time series

Faculty Mentor’s Name: Dr. Azra Bihorac
Phone: (352) 273-9009
Email: abihorac@ufl.edu

Research Project Description:

The purpose of this study is to use clustering to predict pathophysiologic signatures and clinical trajectory during the early stages of acute kidney injury. We hypothesized that clustering analysis of electronic health record data would reveal distinct, predictable patient phenotypes with unique pathophysiological signatures and clinical trajectories.

Entry Date: January 15, 2020

Project Title: Computed tomography hyperdense acute reperfusion marker as a novel biomarker for clinical management in ischemic stroke

Faculty Mentor’s Name: Dr. Alexis Simpkins
Phone: (352) 273-5556
Email: alexis.simpkins@neurology.ufl.edu

Research Project Description:

Hyperintense acute reperfusion marker (HARM) on post-contrast magnetic resonance imaging (MRI) fluid attenuated inversion recovery (FLAIR) represents gadolinium contrast extravasation in the setting of acute ischemic stroke and is a common finding after revascularization therapies. Clinically, it is a marker of blood brain barrier (BBB) disruption and predictor of hemorrhagic transformation and poor clinical outcomes in ischemic stroke. Similarly, contrast extravasation can be seen in the early phase of acute stroke after iodinated contrast administration on computed tomography (CT) imaging. This iodinated contrast extravasation can mimic the appearance of intracerebral hemorrhage and thereby affect clinical management. Dual-energy CT (DECT) imaging is able to overcome this obstacle by differentiating blood from iodinated contrast. With this in mind, we hypothesize that DECT may be used as a more cost-effective and readily available imaging biomarker relative to MRI. This will be a retrospective cohort study whose purpose will be to investigate the utility and practicality of a CT hyperdense acute reperfusion marker following ischemic stroke and reperfusion therapies. Further subgroup analysis will be used to correlate if specific patient factors (e.g., peripheral monocyte count, renal function, location of stroke, etc.) predict the risk of BBB dysfunction post-revascularization. The medical student(s) will assist with data collection and analysis.

Entry Date: January 23, 2020

Project Title: Endocrinology Consultation Effect on Stroke Outcomes

Faculty Mentor’s Name: Dr. Alexis Simpkins
Phone: (352) 273-5556
Email: alexis.simpkins@neurology.ufl.edu

Research Project Description:

Diabetes is independently associated with increased risk for acute ischemic stroke. While it is known that diet, exercise, and glucose control are important for preventing major cardiovascular events such as ischemic stroke, the effectiveness of diabetes education and medication titration for long-term glucose control in patients that have recently suffered an acute ischemic stroke is less clear. Several clinical trials have shown a benefit for education and support in lifestyle modification for stroke prevention, including long-term glucose control. While tight glucose control during hospitalizations for stroke has not been shown to be beneficial in the acute setting per the results of the SHINE clinical trial, effects of medication management aimed at long-term glucose control strategies recommended by consulting endocrinology services are unknown. Education for glucose control and lifestyle modification for stroke prevention in diabetics can vary institutionally. Studies have focused on post discharge care as well as secondary stroke prevention in the context of clinical trials, however there have been very little population based outcome studies that evaluate current therapies available for glucose control and take into account more recent insurance payer models. Our current model is to obtain an endocrinology consultation and a consultation with a diabetes educator for patients with hemoglobin A1c >8% prior to discharge from the hospital. To date, the effectiveness of this model has not been studied. ​Medical student role for this project would include chart review and assistance with data collection.

Entry Date: January 23, 2020

Project Title: Factors affecting recovery and long-term prognosis following acute motor (AMAN) and motor-sensory axonal neuropathy (AMSAN) Guillain-Barre Syndrome variants

Faculty Mentor’s Name: Dr.Miguel Chuquilin
Phone: (314) 322-6363
Email: miguel.chuquilin@neurology.ufl.edu

Research Project Description:

This study aims to identify prognostic factors and characterize long term prognosis in patients with acute motor (AMAN) and motor-sensory axonal neuropathy (AMSAN) forms of Guillain-Barre Syndrome (GBS). These two subtypes of GBS are understudied, as these are less common in the US compared to the demyelinating forms of GBS. Multiple previous prognostic studies have been conducted for patients with the demyelinating form, but this data cannot be generalized to the axonal forms of GBS that are thought to have worse prognosis. Additionally, there is a study that looked only at short term outcomes in axonal neuropathies. Thus, we aim to identify how patient demographics (specifically age), disease progression (time from symptom onset to admission, time to maximum weakness, autonomic or bulbar dysfunction, need for and duration of mechanical ventilation), and other potential laboratory markers (presence of cytoalbuminologic dissociation in CSF or various ganglioside auto-antibodies) impact the recovery of patients in the long term (time to achieve independent walking status as determined by the GBS disability score, and overall muscle strength as measured by the MRC sum score) up to one year in follow-up. This data can begin to provide useful information than can be used clinically to counsel patients and families seeking information regarding expected recovery. The study involves review of medical records in the epic electronic medical record system. IRB for this study is already approved.

Entry Date: April 17, 2020