28 results on '"Kraleti S"'
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2. The Importance of a Champion in Leading Major Improvements in Residency Programs.
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Kraleti S, Gibson-Oliver L, and Jarrett DM
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Background and Objectives: Residency programs are expected to meet many requirements in training their residents, including providing adequate numbers of pediatric visits and procedures opportunities. In the residency program studied here, these numbers were inadequate, despite the efforts of faculty members over the years. A self-designated faculty champion (with traits including vision, persuasiveness, proactivity, and tenacity) launched a series of clinical initiatives to combat these problems., Methods: The number of pediatric visits in the Family Medical Center (FMC) were tracked and compared from 2012, prior to the intervention led by the faculty champion, through 2023. The number of procedures performed in the FMC were tracked and compared from 2015, when the procedures-only clinic was launched by the faculty champion, through 2023., Results: The number of pediatric visits in the FMC in 2012-2013 was a total of 12. By 2022-2023, that number had grown to 1,454. The number of procedures in the FMC was four in 2015-2016, but by 2022-2023 had grown to 470. The improved numbers support competency-based medical education, with increased faculty observation, teaching, and evaluation. For procedures training, the improved numbers support faculty members in using the Procedural Competency Assessment Tools to evaluate resident performance., Conclusions: A faculty champion who is interested, self-motivated, persistent, and focused on leading the project from beginning to end can bring about significant improvements in a residency program, despite the program's track record of difficulty in making such improvements.
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- 2024
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3. Understanding HPV Vaccine Hesitancy and What Helped Hesitant Adopter Parents Have Their Children Vaccinated Despite Their Hesitancy.
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Purvis RS, Moore R, Willis DE, Li J, Kraleti S, Imran T, and McElfish PA
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- Humans, Female, Male, Child, Adult, Health Knowledge, Attitudes, Practice, Adolescent, Vaccination psychology, Qualitative Research, Papillomavirus Vaccines administration & dosage, Parents psychology, Papillomavirus Infections prevention & control, Vaccination Hesitancy psychology, Vaccination Hesitancy statistics & numerical data, Patient Acceptance of Health Care psychology, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Introduction: One out of four parents reported HPV vaccine hesitancy; however, little is known about HPV vaccine-hesitant parents who vaccinate their children (e.g., hesitant adopters)., Method: We use individual interviews (n = 8) to explore hesitancy and facilitators for overcoming hesitancy among hesitant adopter parents. We drew a priori codes from the Increasing Vaccination Model domains and identified seven emergent secondary themes., Results: Understandable information about safety, side effects, and effectiveness could address HPV vaccine hesitancy. Health care professionals, family, friends, and coworkers were trusted vaccine and vaccination information sources. The study documents the lack of access to HPV vaccines with established health care providers as a barrier to vaccination., Discussion: This is the first study of hesitant adopter parents that expands our understanding of factors driving HPV vaccination among them. Study insights can inform future efforts to increase HPV vaccine uptake among the hesitant., Competing Interests: CONFLICTS OF INTEREST None to report., (Copyright © 2023 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)
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- 2024
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4. Exploring Hesitancy, Motivations, and Practical Issues for COVID-19 Vaccination Among Vaccine-Hesitant Adopter Parents Using the Increasing Vaccination Model.
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Purvis RS, Moore R, Willis DE, Li J, Selig JP, Kraleti S, Imran T, and McElfish PA
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- Humans, Female, Male, Adult, Child, SARS-CoV-2, Vaccination psychology, Patient Acceptance of Health Care psychology, Patient Acceptance of Health Care statistics & numerical data, Child, Preschool, COVID-19 Vaccines administration & dosage, Parents psychology, COVID-19 prevention & control, COVID-19 psychology, Vaccination Hesitancy psychology, Vaccination Hesitancy statistics & numerical data, Motivation, Qualitative Research
- Abstract
Introduction: COVID-19 vaccination coverage among children remains low, and many parents report being hesitant to get their children vaccinated. This study explores factors influencing hesitancy and the facilitators that helped hesitant adopter parents choose to vaccinate their children against COVID-19 despite their hesitancy., Method: We use a qualitative descriptive design with individual interviews (n = 20) to explore COVID-19 vaccine hesitancy and facilitators of vaccination among hesitant adopter parents. The Increasing Vaccination Model domains (thoughts and feelings, social processes, and practical issues) provided the framework for initial coding, and the research team identified nine emergent themes., Results: Findings document the factors influencing hesitancy and the facilitators motivating COVID-19 vaccination among hesitant adopter parents., Discussion: Findings fill the gap in the literature by providing hesitant adopters' lived experience, perspectives on vaccine hesitancy, and the influential factors that helped participants overcome their hesitancy and choose to vaccinate their children against COVID-19., Competing Interests: CONFLICTS OF INTEREST None to report., (Copyright © 2024 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)
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- 2024
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5. "Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine.
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Moore R, Purvis RS, Willis DE, Li J, Langner J, Gurel-Headley M, Kraleti S, Curran GM, Macechko MD, and McElfish PA
- Abstract
COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.
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- 2024
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6. Understanding Vaccination Among Hesitant Adopters of the COVID-19 Vaccine Using the Increasing Vaccination Model.
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Moore R, Purvis RS, CarlLee S, Hallgren E, Kraleti S, Willis DE, and McElfish PA
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- Humans, COVID-19 Vaccines, Vaccination, Altruism, COVID-19 epidemiology, COVID-19 prevention & control, Health Communication
- Abstract
The coronavirus disease (COVID-19) was the third leading cause of death in 2021 in the United States and has led to historic declines in life expectancy for Americans. While vaccination is an effective mitigation strategy for COVID-19, vaccine hesitancy remains a major barrier to individual and population-level protection. An emerging literature on hesitant adopters of COVID-19 vaccines highlights co-occurrence of hesitancy and vaccine uptake as an understudied phenomenon, with the potential to provide insight into factors that lead hesitant individuals to become vaccinated despite their hesitancy. We use qualitative interviews among hesitant adopters in Arkansas to examine vaccine hesitancy among this understudied group. Drawing on the Increasing Vaccination Model, we find that the most frequently reported motivations of hesitant adopters were within the domain of social processes, pointing to a critical focal point for targeted health communications intervening in this domain (e.g. social norms, social networks, and altruistic behavior). We find that recommendations from health care workers (HCWs) other than physicians/providers may serve as an effective influence to vaccinate. We also demonstrate negative effects of low provider and HCW confidence and weak recommendations on motivations to vaccinate among individuals expressing vaccine hesitancy. Additionally, we find individual information-seeking behaviors among hesitant adopters bolstered confidence in the efficacy of the COVID-19 vaccine. Based on these findings, clear, accessible, and authoritative health communication has a role in combatting the COVID-19 misinformation/disinformation infodemic.
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- 2023
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7. An Innovative Resource to Guide and Track Medical Resident Activity and Wellness During At-Home Assignments.
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Jarrett DM, Gibson-Oliver L, and Kraleti S
- Abstract
Background and objectives Medical residents may work from home for various reasons, including study electives, isolation due to exposure to illness, or during parental leave when they choose to work at home instead of taking extended time off. The University of Arkansas for Medical Sciences (UAMS) Little Rock Family Medicine residency program recognized the need for a tool that provided residents with a list of resources and approved activities for at-home work and a means of tracking their performance in those activities. Methods The administration team at the UAMS Little Rock Family Medicine residency program custom-designed a Daily Activities Log that served multiple purposes. Family medicine residents used it to choose what activities to participate in from a comprehensive list of activities and resources including virtual conferences, recorded didactics, modules, and other online materials. The program provided the framework on the log, while residents used it to document time spent on those activities. The log also gave the program a daily update on the resident's health, as one question specifically asked about well-being. Since it was built in an electronic survey format already owned by the residency program, it was completely customizable and available at no additional cost. Results In the two years covered by this project, residents logged a total of 593 hours of at-home work. In response to a survey, 76% of participating residents (N=14) rated the log as extremely or very easy to use; 64% indicated that it was a helpful resource; and 50% said that it simplified the reporting of their daily status. The residency program faculty found that having one source to track all off-site residents was an efficient means of monitoring their well-being and their work. Conclusions The Daily Activities Log is a versatile tool that provides comprehensive information, resources, and approved activities for residents, documents their work, and provides updates to residency management. It can be readily modified for use in other programs that have residents working at home., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Jarrett et al.)
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- 2023
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8. Associations between Influenza Vaccination and Health Care Access among Adults in the United States.
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Gurel-Headley M, Mamisashvili M, CarlLee S, Reece S, Chapman C, Kraleti S, Andersen JA, Selig JP, Willis DE, Li J, and McElfish PA
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Few studies have investigated the relationship between influenza vaccination and health care access. Furthermore, despite the well-documented disparities in vaccine coverage for communities of color, few studies have examined how experiences of discrimination may influence vaccine uptake. To fill this gap in the literature, this study examined associations between 5-year influenza vaccination rates and sociodemographic characteristics, health care access, and racial discrimination. Age, race/ethnicity, education, health care coverage, primary care provider, no medical care due to cost, and routine doctor checkups were significant correlates of 5-year influenza vaccination. In contrast to previous studies, discrimination scores were not a significant correlate of regular influenza vaccination. Respondents who reported forgoing care due to cost were less likely to report vaccination every year out of the last 5 years compared to all of the less frequent categories combined, demonstrating a more complex association between sometimes not being able to afford medical care and influenza vaccination. Future research should examine the relationship between influenza vaccination uptake, racial discrimination, and forgone care due to cost to enhance resources and messaging for influenza vaccination uptake.
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- 2023
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9. Giant cell tumor of the bone presenting as swelling of the thumb.
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Kraleti S, Manyam S, and Dawson K
- Abstract
We describe a giant cell tumor in a 74-year-old man who presented with pain and swelling in the left thumb. Radiographs of the left hand showed some lytic changes at the tip of the thumb. Magnetic resonance imaging suggested the diagnosis of giant cell tumor, which was later confirmed by biopsy. A good treatment response was achieved with disarticulation of the interphalangeal joint and amputation of the distal phalanx of the left thumb., (Copyright © 2020 Baylor University Medical Center.)
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- 2020
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10. Eruptive Lichen Planus Associated With Chronic Hepatitis C Infection Presenting as a Diffuse, Pruritic Rash.
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Beck PB, Goksel M, and Kraleti S
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Lichen planus has been associated with several precipitating factors, such as drugs, immunizations, and viral infections, including hepatitis C virus (HCV). Eruptive or disseminated lichen planus is a rare variation that most often presents as an acute, widespread exanthem that progresses rapidly and usually lasts for a shorter duration. This variation has not been well studied, and little is known about the etiologies and treatments of this rare form. Thus far, only a few cases of eruptive lichen planus have been reported to be associated with HCV infection. We report a case a 62-year-old woman who presented with a rapidly progressive, diffuse, pruritic rash of the trunk, upper extremities, and thighs that was determined to be eruptive lichen planus secondary to chronic HCV infection. The patient was treated with topical steroids and oral antihistamines, and her rash spontaneously resolved approximately six months after the initial presentation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Beck et al.)
- Published
- 2020
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11. Hepatosplenic sarcoidosis.
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Kopparapu A, Odathil F, Bajaj G, Jarrett D, and Kraleti S
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Sarcoidosis is a systemic disorder characterized by development of granulomas within various organs in the body. It commonly affects people of African American and Scandinavian heritage between the ages of 20 and 40. The lungs are involved in 90% of patients. We report a case of sarcoidosis of the spleen and liver with minimal pulmonary involvement., (Copyright © 2020 Baylor University Medical Center.)
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- 2020
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12. Extraocular Sebaceous Carcinoma Presenting As a Nodule over the Zygoma.
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Kraleti S, Manyam S, and Dawson K
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We describe a case of sebaceous carcinoma (SC) in a 75-year-old man who presented with a rapidly growing nodule on the left cheek for four weeks. A 75-year-old man presented with a crusted non-tender nodule on the left cheek that had been present for six months. The nodule showed rapid growth in the four weeks before the visit. Shave biopsy of the lesion was reported as SC. SC is a rare but aggressive type of skin cancer that can develop from any sebaceous gland in the body. However, it mostly occurs in the eyelids. In this case, SC developed on the left cheek of the patient, which is an atypical presentation. Extraocular variant of SC has a greater potential to metastasize and has a lower survival rate compared to ocular variant. Early and accurate diagnosis followed by a wide excision surgery or Mohs micrographic surgery carries a favorable prognosis. Early detection of extraocular variant of SC may be difficult. It is imperative for primary care providers to order a histopathology examination to investigate a rapidly growing mass in the head and neck region where there are numerous sebaceous glands., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Kraleti et al.)
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- 2020
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13. A Rising Concern of Loperamide Abuse: A Case Report on Resulting Cardiac Complications.
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Sapra A, Bhandari P, Gupta S, Kraleti S, and Bahuva R
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The purpose of our case report is to generate awareness among the providers about the rising abuse of loperamide, which is a readily available nonprescription medication for its opiate-like actions and the risk of severe cardiac complications as a consequence of the same. It is currently becoming a significant concern among the healthcare fraternity due to its increasing abuse owing to its opioid agonistic activity. Our patient was a 32-year-old female who presented to the ED with ventricular dysrhythmias and persistent, prolonged QT interval secondary to excessively high doses of over-the-counter (OTC) loperamide abuse. More and more cases of loperamide abuse and its cardiotoxic potential are being reported in the literature, highlighting the increasing incidence of this problem., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Sapra et al.)
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- 2019
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14. Treatment of OSA: What (else) can it accomplish?
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Sorsby SC, Kraleti S, and Jarrett D
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Treatment Outcome, Activities of Daily Living psychology, Quality of Life psychology, Sleep Apnea, Obstructive therapy
- Abstract
Treatment of obstructive sleep apnea improves daytime sleepiness, but does it improve other outcomes?
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- 2019
15. Training Residents in Maternal Depression Care to Improve Child Health: A CERA Study.
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Edge NAC, Kraleti S, McKelvey L, Jarrett DM, Sublett JD 2nd, and Bennett IM
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- Canada, Child, Curriculum, Education, Medical, Graduate, Female, Humans, Male, Mass Screening, Maternal Health Services, Surveys and Questionnaires, Child Health, Depression diagnosis, Faculty, Medical statistics & numerical data, Family Practice education, Internship and Residency
- Abstract
Background and Objectives: Untreated maternal depression negatively impacts both the mother and her children's health and development. We sought to assess family medicine program directors' (PDs) knowledge and attitudes regarding maternal depression management as well as resident training and clinical experience with this disorder., Methods: Data were gathered through the Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) national survey of family medicine PDs in US and Canadian programs, from January through February, 2018., Results: Surveys were completed by 298 PDs (57.1% response rate) who were majority male (58.9%) and white (83.8%). Nearly all (90.2%) PDs agreed that family physicians should lead efforts to minimize the impact of maternal depression on child well-being. According to PD report, in the family medicine clinics where residents train, most (77.3%) have a clinic process that ensures that routine screening for depression occurs, and 54.4% do some screening of mothers during pediatric visits. Only 18.2% report routinely taking steps to minimize the impact of the mothers' depression on child well-being. Finally, 41.3% of PDs reported being familiar with the literature on the impact of maternal depression on children; self-reported familiarity was significantly associated with more comprehensive resident training on this topic., Conclusions: Family medicine residency program directors are supportive of training in maternal depression, though their current knowledge is variable and there are opportunities to enhance care of mothers and children impacted by this common and serious disorder.
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- 2019
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16. IgA vasculitis presenting as abdominal pain and rash.
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Kopparapu A, Jarrett D, and Kraleti S
- Abstract
A 57-year-old white man presented with acute abdominal pain and rash without any prodromal symptoms. The skin biopsy confirmed immunoglobulin A (IgA) vasculitis with small vessel vasculitis and perivascular IgA, C3, and fibrin deposition. IgA vasculitis is diagnosed most commonly in children and presents in adults in only 10% of cases. Treatment is usually supportive care, and interventions may be required to avoid complications such as nephrotic syndrome or acute gastrointestinal bleeding. Clinicians should be aware of IgA vasculitis as a potential cause for abdominal pain and rash in adult populations., (Copyright © 2019 Baylor University Medical Center.)
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- 2019
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17. Test of a Conceptual Model to Explain Television Exposure of Head Start Children.
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Swindle TM, Jarrett D, McKelvey LM, Whiteside-Mansell L, Conners Edge NA, and Kraleti S
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- Adult, Child, Preschool, Female, Humans, Male, Models, Organizational, Poverty, Screen Time, Social Support, Stress, Psychological, Surveys and Questionnaires, United States, Child Behavior, Child Welfare, Parent-Child Relations, Parenting psychology, Television statistics & numerical data
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Excessive television (TV) viewing by children can lead to negative health and developmental outcomes. Using structural equation modeling, this study tests a conceptual model to understand social and familial factors associated with TV exposure among a sample of 767 Head Start families with children between the ages of 3 and 5 years. Fit statistics suggested that the overall model provided an acceptable fit to the observed data. Specifically, significant structural paths suggest that parents' social support affects child TV exposure. Additionally, lower levels of social support were associated with significantly greater parental stress, which also predicted child TV exposure. Findings suggest that physicians and other team members of the patient-centered medical home may benefit from broad-based interventions that address familial factors to combat excess TV exposure among children. Urging parents to turn off the TV could fail to address the underlying causes of child TV exposure.
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- 2018
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18. Adverse childhood experiences: Screening and health in children from birth to age 5.
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McKelvey LM, Conners Edge NA, Fitzgerald S, Kraleti S, and Whiteside-Mansell L
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- Adolescent, Adult, Aged, Arkansas, Child, Child, Preschool, Female, Humans, Infant, Logistic Models, Male, Middle Aged, Risk Factors, Social Determinants of Health, Surveys and Questionnaires, Life Change Events, Mass Screening methods
- Abstract
Introduction: Adverse childhood experiences (ACEs) have lifetime consequences for health and development. This study examined whether there is evidence to support a screening approach that assesses children's current exposures to risks that act as proxies for ACEs, measured in a way that falls below a threshold of explicit abuse, neglect, or illegal behavior., Method: We used data collected during routine home visitations of at-risk children aged 0-5. Home visitors used the Family Map Inventories (FMI; Whiteside-Mansell et al., 2007) to screen ACEs and measure health outcomes, and the Ages and Stages Questionnaire (3rd ed.; ASQ-3; Squires, Twombly, Bricker, & Potter, 2009) to screen child development. Parents (N = 2,004) were 28 years of age on average and most were White (60%). Children were 32 months of age on average and equally divided on gender (51% male)., Results: Children were exposed at rates of 27%, 17%, 11%, and 11% to 1, 2, 3, and 4 or more FMI-ACEs, respectively. Logistic regressions revealed significant associations between FMI-ACE scores and health environments and outcomes for children, including health risks in the home (e.g., safety and secondhand smoke exposure), underuse of preventive health care, and overuse of emergency medical treatment. In terms of development, having four or more FMI-ACEs was associated with the child having a chronic health condition and screening at risk for delay in at least one area of development., Discussion: Findings highlight the potential use of questionnaires and in-home observations to measure and intervene in potentially developing ACEs. Further, our screening was associated with children whose health was at risk very early in development. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)
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- 2017
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19. Clinical Review of Antidiabetic Drugs: Implications for Type 2 Diabetes Mellitus Management.
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Chaudhury A, Duvoor C, Reddy Dendi VS, Kraleti S, Chada A, Ravilla R, Marco A, Shekhawat NS, Montales MT, Kuriakose K, Sasapu A, Beebe A, Patil N, Musham CK, Lohani GP, and Mirza W
- Abstract
Type 2 diabetes mellitus (T2DM) is a global pandemic, as evident from the global cartographic picture of diabetes by the International Diabetes Federation (http://www.diabetesatlas.org/). Diabetes mellitus is a chronic, progressive, incompletely understood metabolic condition chiefly characterized by hyperglycemia. Impaired insulin secretion, resistance to tissue actions of insulin, or a combination of both are thought to be the commonest reasons contributing to the pathophysiology of T2DM, a spectrum of disease originally arising from tissue insulin resistance and gradually progressing to a state characterized by complete loss of secretory activity of the beta cells of the pancreas. T2DM is a major contributor to the very large rise in the rate of non-communicable diseases affecting developed as well as developing nations. In this mini review, we endeavor to outline the current management principles, including the spectrum of medications that are currently used for pharmacologic management, for lowering the elevated blood glucose in T2DM.
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- 2017
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20. Persistent fever investigation saves patient's life.
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Busch M, Priyambada P, Wells T, Jarrett D, and Kraleti S
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- Female, Fever of Unknown Origin diagnosis, Humans, Lymphohistiocytosis, Hemophagocytic diagnosis, Middle Aged, Posterior Leukoencephalopathy Syndrome diagnosis, Posterior Leukoencephalopathy Syndrome therapy, Treatment Outcome, Fever of Unknown Origin drug therapy, Fever of Unknown Origin etiology, Lymphohistiocytosis, Hemophagocytic drug therapy, Lymphohistiocytosis, Hemophagocytic etiology, Posterior Leukoencephalopathy Syndrome complications, Rare Diseases diagnosis, Rare Diseases drug therapy
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A 47-year-old woman had been hospitalized one month earlier for lupus nephritis with a hypertensive emergency that led to a seizure. During this earlier hospitalization, she was given a diagnosis of posterior reversible encephalopathy syndrome.
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- 2016
21. Epistaxis, mass in right nostril · Dx?
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Kraleti S and Jarrett D
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- Diagnosis, Differential, Female, Granulation Tissue physiopathology, Humans, Middle Aged, Treatment Outcome, Epistaxis diagnosis, Epistaxis surgery, Granulation Tissue diagnostic imaging, Granulation Tissue surgery, Granuloma, Pyogenic diagnosis, Granuloma, Pyogenic surgery
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A 49-year-old woman visited our family medicine clinic because she'd had 3 episodes of epistaxis during the previous month. She'd already visited the emergency department, and the doctor there had treated her symptomatically and referred her to our clinic.
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- 2016
22. Piperacillin-Tazobactam Induced Interstitial Nephritis, Hepatitis and Serum Sckness-Like Illness.
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Kraleti S, Khatri N, and Jarrett D
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- Adult, Female, Humans, Penicillanic Acid adverse effects, Piperacillin adverse effects, Piperacillin, Tazobactam Drug Combination, Anti-Bacterial Agents adverse effects, Chemical and Drug Induced Liver Injury etiology, Nephritis, Interstitial chemically induced, Penicillanic Acid analogs & derivatives, Pneumonia drug therapy, Serum Sickness chemically induced
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Objective: To describe a patient who developed acute interstitial nephritis, hepatitis and serum sickness-like syndrome after receiving piperacillin-tazobactam (zosyn) therapy., Case Summary: A 30-year-old woman received a 7-day course of piperacillin-tazobactam as empiric treatment for pneumonia. The patient's kidney function worsened and she turned anuric needing dialysis. She also developed fever and a rash. Laboratory analysis showed elevated liver function and leukocytosis. Kidney biopsy showed acute interstitial nephritis. The patient responded well to steroids; white blood cell count normalized and her liver and kidney function improved over a period of one month., Discussion: Piperacillin-tazobactam is one of the most commonly used antibiotics in the hospital setting. It has rarely been associated with acute interstitial nephritis, hepatic injury, or serum sickness-like reactions. Steroids have improved the outcome in most of the cases of interstitial nephritis., Conclusion: Clinicians should be aware of piperacillin-tazobactam as a drug capable of causing interstitial nephritis, hepatitis and serum sickness-like syndrome. It is essential that we monitor for these rare but severe complications.
- Published
- 2016
23. Low-Level Symptoms of Depression in Mothers of Young Children are Associated with Behavior Problems in Middle Childhood.
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Conners-Burrow NA, McKelvey L, Perry D, Whiteside-Mansell L, Kraleti S, Mesman G, Holmes K, and Kyzer A
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- Child, Child Behavior Disorders diagnosis, Depression epidemiology, Depression etiology, Depression psychology, Emotions physiology, Female, Humans, Infant, Longitudinal Studies, Male, Psychiatric Status Rating Scales, Severity of Illness Index, Child Behavior Disorders psychology, Child of Impaired Parents, Depression diagnosis, Internal-External Control, Mother-Child Relations, Mothers psychology, Parenting psychology
- Abstract
Objectives: Examine the association between mothers' low- and high-level depressive symptoms in early childhood and children's behavior problems in middle childhood., Methods: We used data from 1844 families in a multi-site, longitudinal study beginning when children were 14 months and continuing to age 11 years. Children's internalizing and externalizing behavior problems at age 11 were assessed using the child behavior checklist for ages 6-18. Mothers' scores on the Center for Epidemiological Studies-Depression Scale when children were 14 months were used to classify them into three groups: 'no depressive symptoms', 'low-level depressive symptoms (below the clinical cut-off)' and 'clinically significant depressive symptoms (above the clinical cut-off).', Results: Mothers were racially/ethnically diverse, including Caucasian (38.9 %), African-American (34.4 %), Hispanic (21.6 %), or other (5.1 %). More than one-third (39.2 %) were teenaged mothers, and 46.0 % did not complete high school. Of the 1844 families, 1172 had age 11 child outcome data. Logistic regression analyses controlling for family demographics revealed a significant association between early maternal depressive symptoms and later child behavioral outcomes. Both low level and clinically significant symptoms were associated with internalizing and externalizing behavior problems. For example, children whose mothers had low-level depressive symptoms were twice as likely to have clinically elevated internalizing problems compared with children whose mothers never had symptoms of depression., Conclusions: Children whose mothers experience low-level depressive symptoms early in their development have increased risk for later behavioral problems, suggesting a possible need for new screening and intervention strategies for mothers with lower than clinically elevated symptoms.
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- 2016
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24. Budd-Chiari Syndrome in a patient with Multiple Hypercoagulopathies.
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Kraleti S
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- Adult, Anticoagulants therapeutic use, Budd-Chiari Syndrome diagnosis, Elective Surgical Procedures methods, Humans, Hypertension, Portal diagnosis, Liver Cirrhosis diagnosis, Male, Treatment Outcome, Venous Thrombosis complications, Venous Thrombosis therapy, Budd-Chiari Syndrome complications, Budd-Chiari Syndrome therapy, Hypertension, Portal complications, Hypertension, Portal therapy, Liver Cirrhosis complications, Liver Cirrhosis therapy, Liver Transplantation
- Abstract
Objective: To describe a patient with Budd-Chiari syndrome (BCS) found to have multiple hypercoagulopathies., Case Summary: A 33-year-old man who presented with abdominal distension, hematemesis, shortness of breath was found to have liver cirrhosis, portal hypertension and Budd-Chiari Syndrome. He was evaluated for hypercoagulability and was found to be heterozygous for Factor V Leiden mutation and his protein C level was 38% of normal. He was started on oral anticoagulation and underwent elective liver transplantation within 3 months of diagnosis., Discussion: In patients with Budd-Chiari syndrome, factor V Leiden is the second most commonly identified prothrombotic state after primary myeloproliferative disorders. There may be a coexistence of several thrombophilic states in patients with Budd-Chiari Syndrome., Conclusions: Budd-Chiari syndrome is an uncommon disorder. Outcome is poor in many cases. Therefore, a successful diagnostic and therapeutic approach is of vital importance. A complete thrombophilia screening needs to be requested in all patients diagnosed with Budd-Chiari syndrome. Thorough investigation needs to be performed to identify an underlying process contributing to the hepatic venous outflow obstruction.
- Published
- 2015
25. Low-level depressive symptoms reduce maternal support for child cognitive development.
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Conners-Burrow NA, Bokony P, Whiteside-Mansell L, Jarrett D, Kraleti S, McKelvey L, and Kyzer A
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- Adult, Child, Preschool, Early Intervention, Educational, Female, Humans, Male, Mass Screening, Odds Ratio, Social Support, Surveys and Questionnaires, Child Development, Child of Impaired Parents, Depression diagnosis, Mother-Child Relations psychology, Mothers psychology, Parenting psychology, Poverty psychology
- Abstract
Objective: The objective of this study was to examine the relationship between low-level depressive symptoms in mothers and their support for child cognitive development., Methods: Participants included 913 low-income mothers of preschool-age children who were screened for maternal depression and interviewed about support for learning in the child's home environment., Results: Of the 770 mothers in the analysis, 21.5% reported low-level depressive symptoms (below the cutoff on the screening tool indicating clinically elevated symptoms). Logistic regression analyses revealed that children of mothers with low-level depressive symptoms were significantly less likely to experience six of seven types of support for learning compared with children of mothers with no depressive symptoms., Conclusions: Results suggest that children whose mothers experience even low-level depressive symptoms are less likely to receive important supports for cognitive development and school readiness, pointing to the need for screening and interventions to address maternal depression at all levels of severity., (Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
26. Pancytopenia and lactic acidosis associated with linezolid use in a patient with empyema.
- Author
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Kraleti S and Soultanova I
- Subjects
- Acidosis, Lactic complications, Adult, Humans, Linezolid, Male, Pancytopenia complications, Acetamides adverse effects, Acidosis, Lactic chemically induced, Anti-Infective Agents adverse effects, Empyema, Pleural drug therapy, Oxazolidinones adverse effects, Pancytopenia chemically induced
- Abstract
Objective: To describe a patient who developed pancytopenia and lactic acidosis after receiving linezolid therapy., Case Summary: A 32-year-old man with past medical history of heart failure, hypertension received a 14-day course of linezolid for treatment of empyema with broncho-pleural fistula. During his follow up visit, he was found to be septic and further evaluation showed pancytopenia, acidosis and elevated liver enzymes. With the exclusion of other possible etiologies, the time course to development of these laboratory abnormalities correlated with the use of linezolid. Antibiotics were switched subsequently and the labs improved after reaching a nadir on the fourth day after stopping linezolid., Discussion: Linezolid was noted to cause time and dose-dependent reversible myelosuppression in preclinical studies. There are several case reports of throinbocytopenia occurring with linezolid use, but only few cases of pancytopenia and lactic acidosis are reported. Exact mechanism of toxicity is unknown, but many hypothesize it to be similar to chloramphenicol marrow toxicity because of the cross-reactivity to mitochondrial ribosomes., Conclusions: Clinicians should be aware of linezolid as a drug capable of causing pancytopenia, lactic acidosis and elevated liver enzymes. While recovery is usually complete following withdrawal of the drug, we need to still monitor for these rare but severe complications; and consider treating only for a shorter duration, if possible.
- Published
- 2013
27. Violence exposure as a predictor of internalizing and externalizing problems among children of substance abusers.
- Author
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Conners-Burrow N, McKelvey L, Kyzer A, Swindle T, Cheerla R, and Kraleti S
- Subjects
- Adult, Anxiety epidemiology, Anxiety physiopathology, Child, Child Behavior Disorders epidemiology, Child Behavior Disorders psychology, Environment, Female, Humans, Male, Mental Health, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Self Concept, Substance-Related Disorders diagnosis, Substance-Related Disorders psychology, United States, Violence statistics & numerical data, Anxiety etiology, Child Behavior Disorders etiology, Child Welfare, Mother-Child Relations psychology, Substance-Related Disorders complications, Violence psychology
- Abstract
We explore the associations between exposure to conflict and crime in the home and community, and child anxiety and self-control problems among 60 children whose mothers were in treatment for substance abuse problems. Experiences with violence and crime were widespread, with many children exposed to multiple incidents. Approximately one-third (35.5%) of children exhibited clinically elevated anxiety. Controlling for other potential predictors, both children's exposure to violence and the number of years the mother had been using substances predicted higher anxiety in children, while only exposure to violence predicted problems in self-control. Results highlight the importance of screening for violence exposure., (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
28. Maternal low- and high-depressive symptoms and safety concerns for low-income preschool children.
- Author
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Conners-Burrow NA, Fussell JJ, Johnson DL, McKelvey LM, Whiteside-Mansell L, Bokony P, and Kraleti S
- Subjects
- Adult, Child, Preschool, Early Intervention, Educational, Female, House Calls, Humans, Logistic Models, Odds Ratio, Risk, Surveys and Questionnaires, Violence psychology, Violence statistics & numerical data, Depression diagnosis, Mothers psychology, Poverty psychology, Safety statistics & numerical data
- Abstract
Objectives: Our objective was to examine the relationship between low- and high-level depressive symptoms in mothers' and children's risks in the areas of home and car safety, monitoring, and exposure to violence., Methods: Participants included 978 mothers of preschool-age children who were interviewed about their home environment and screened for maternal depression., Results: Whereas only 5.7% scored at high depressive levels on the screen, another 21.3% scored at low depressive levels. Logistic regression analyses controlling for demographics revealed that children were significantly more likely to experience home safety risks in 6 of 7 areas when mothers reported either low or high levels of depressive symptoms., Conclusions: Results suggest that children whose mothers experience even low-level depressive symptoms are at increased risk for safety problems in the home environment, pointing to the need for screening and interventions to reduce the risk of injury.
- Published
- 2013
- Full Text
- View/download PDF
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