Traumatic injury is now a major burden on the health of the Guatemalan people. Interpersonal violence is the second leading cause of Disability-adjusted Life Years (DALYs) in Guatemala, and homicide, suicide, conflict and unintentional injuries account for an estimated 900 thousand years of life lost due to premature mortality. There is a need to understand the impact of trauma in Guatemala and to create targeted health policy initiatives to relieve this burden on the health of the country.
Trauma/Acute Care Research
Trauma is a time-sensitive disease and rapid access to definitive care is critical. However, access to trauma care is not geographically uniform in the US. Patients injured in rural areas have worse outcomes than those injured in urban areas. The mechanisms leading to this disparity remain unclear. Under-triage may play are role which occurs when patients with serious injuries are taken to non-trauma centers. Patients who are first transported to a non-trauma center and then transferred later to a trauma center have higher mortality than those taken initially to a trauma center.
Optimizing blood transfusion services in lower middle income countries is a major health challenge and a social imperative, as postpartum hemorrhage, malarial anemia, sickle cell disease, and all other forms of acute hemorrhage claim millions of lives each year across the world. For this new project, Drs. Kumar and Puyana assembled an international, multidisciplinary team to explore gaps and identify solutions across the blood continuum in a diverse set of sociopolitical contexts within Kenya’s current health setting.
In this study, we will use various machine learning methods to predict the outcomes of non-operative management of small bowel obstructions.
An analysis of all patients at UPMC Presbyterian Shadyside over the past 10 years to develop a demographic profile of patients with Clostridium difficile infection, as well as to identify predictors of a complicated disease course. The study will also include the development of computable phenotypes of disease (phekb.org) for both routine and complicated Clostridium difficile infection.
This will be a retrospective, single-center observational study of patients admitted to the UPMC Presbyterian Medical Intensive Care Unit over a 5-year period. Adult patients (i.e., >18 years of age) who are mechanically ventilated for at least 48 hours and received at least one unit of packed red blood cells will be cross-referenced with reported infection control data and relevant Central Blood Bank data (e.g., storage duration, whether leukoreduced) by a third-party to create a single data set.
People sustaining trauma have distinct recovery and non-recovery clinical trajectories, a difference that is incompletely explained by subject characteristics or the magnitude of injury. Recent data suggest that the non-recovery of trauma is the consequence of underlying changes within the genetic landscape of the immune system. This prospective study seeks to address the following hypothesis: There is a correlation between epigenetic changes of the immune stem cell within the bone marrow and the clinical phenotype and trajectory of persons sustaining trauma.
Our murine studies suggest that exposure to blue (480nm) light, by comparison to ambient white or amber (580nm) light, reduces the inflammatory response (i.e., cytokine concentration), risk of organ failure (i.e., kidney failure), and improves the clearance and control of the infectious focus (i.e., reduced abdominal and pulmonary bacterial counts and bacterial dissemination into tissues of the liver and spleen) in mice subjected to a model of cecal ligation and puncture (CLP) or a model of pneumonia. These data directly support the proposed project and experimentation.
Improving the effectiveness of trauma resuscitation in the emergency department is a major priority for the United Sates health care system. The underlying hypothesis of this research is that a major determinant of resuscitation effectiveness is the presence of a well-developed transactive memory system (TMS), a collective systems for encoding, storing and retrieving information. The overall goal of this study is to determine the link between TMS and trauma team performance.
Venous thromboembolic disease (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and preventable source of post-operative morbidity and mortality. The high incidence of VTE reflects both underutilization of standard thromboprophylactic regimens and also an incomplete understanding of how surgery and critical illness affect the risk of post-operative VTE over time.