Division of Infectious Diseases

DANCE FOR A CHANCE with UNMC ID’s Dr. Diana Florescu

There are hundreds of homeless youth in Omaha. Some of them have been emotionally, physically, or sexually abused, making it unsafe for them to return home, while others are facing health, mental health, or substance abuse issues. Youth Emergency Services (YES) provides much needed services for these individuals.

What is YES Dance for a Chance? Dance for a Chance is an event where local representatives from several companies compete to raise awareness and money for YES and the homeless youth of Omaha. This event and all of its proceeds are for the homeless youth of Omaha. At the end of the competition, there will be 3 winners – the team with the most votes (money), the team with the best dance, and most importantly, the homeless youth of Omaha. More information can be found here.

Dr. Diana Florescu, Associate Professor in the Division of Infectious Disease, is the UNMC representative in the 2018 Dance for a Chance competition. She is partnering with Derek Pasqualetto, instructor and owner of Vintage Ballroom.

In the following weeks, there will be updates and sneak peeks of the campaign. Your support is needed to help provide critical resources to homeless youth and to bring the trophy to UNMC. You will be able to follow us on Facebook.

Voting is open NOW! Click here to vote for Dr. Diana Florescu or make a donation to YES Omaha.

Please support and cheer on Dr. Diana Florescu and her partner at the Dance for a Chance event! The event will take place on Friday, August 3, 2018 at 6:00 p.m., at the Omaha Design Center, 1502 Cuming St Omaha, NE 68102. Get 10 friends together and purchase a table! If interested please contact Dr. Florescu at dflorescu@unmc.edu.

Thank you in advance for all the support!!!

Content provided by Ada Florescu

Interested in Orthopedic Infectious Diseases? The Perfect Job Awaits You at UNMC!

Orthopedic Infectious Diseases
University of Nebraska Medical Center – Omaha, NE

The University of Nebraska Medical Center (UNMC) is excited to announce the recruitment of a faculty position in Orthopedic-ID in the Division of Infectious Diseases, Department of Internal Medicine. Successful candidates will hold an academic appointment at the assistant or associate professor level and will be employed by UNMC and Nebraska Medicine. Candidates should be Board Eligible/Certified in Infectious Diseases.

A generous compensation package with salary commensurate with experience will be offered. Candidates should have an enthusiasm for patient care, teaching, and clinical research. Generous protected time and support are available in order to conduct collaborative clinical research and achieve the goals of the program.

Opportunity Highlights:
– Join established ID Physicians, two Advanced Practice Providers, an ID-trained Pharmacist, and dedicated pharmacy technician in a newly established Orthopedic ID Service Line and support the Outpatient Antimicrobial Therapy (OPAT) Program
– Partner with an internationally-recognized Antimicrobial Stewardship Team to develop and implement OPAT at Nebraska Medicine
– Participate in teaching of medical students, residents, and ID fellows on the Ortho ID consult service

The successful applicant will also participate in the clinical, teaching, and research programs of the Infectious Diseases Division – a vibrant and growing division made up of 18 ID faculty.

Translational research between the Ortho ID program and the Center for Staphylococcal Research is encouraged.

Learn more about UNMC ID on our website and the UNMC ID blog. You can also follow our Division on Twitter @UNMC_ID.

Interested candidates should submit a letter of interest and CV to:

Mark Rupp, MD
Chief, Division of Infectious Diseases
University of Nebraska Medical Center
985400 Nebraska Medical Center
Omaha, NE 68198-9400
Email: merupp@unmc.edu

UNMC ID Division Accolades!

Our Faculty at University of Nebraska Medical Center Division of Infectious Diseases have worked hard to maintain a strong academic presence at UNMC. We are a growing division, filled with faculty at all stages of their careers, and their collective academic prowess has our division leading the pack. Our recent Department of Medicine Research report for 2017 pegged UNMCID as the #1 Division for the number and amount of extramural contracts/awards and #2 for number of publications (out of 10 Divisions in Internal Medicine). We recently had several posters and oral presentations presented at #CROI2018, #SHEA2018 and #ECCMID2018. We are proud of our faculty and would like to share some of their accomplishments with our followers.

Dr. Alison Freifeld has been invited to speak at #IDWeek2018 on new developments in the management of cancer patients, and she is on the steering committee for the American Council on Education (ACE) program at UNMC: goal is to internationalize our campus/curriculum/student body.  This program is mandated by the Chancellor and reflects UNMC’s commitment to expanding our efforts in international engagement and global health education and research.

Dr. Jasmine Marcelin was recently co-recipient of the award for Outstanding multi-site Quality Improvement Project for 2017 – Mayo Clinic Quality Review Board {Project: Management of Febrile Neutropenia (MOFN), completed as a fellow with Drs. Jack O’Horo and Omar Abu Saleh}. Dr. Marcelin also co-authored recently published papers about  Mycobacterium genavense infections in non-HIV immunocompromised hosts (Infectious Diseases) and Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism: A Systematic Review and Meta-analysis of Cases, 1923–2016 (Clinical Infectious Diseases).

Dr. Susan Swindells was recently highlighted in ground-breaking research likely to change the paradigm of latent TB treatment in persons living with HIV; presented at #CROI2018: One Month of Rifapentine/Isoniazid to Prevent TB in People with HIV.   Dr. Swindells also collaborated with UNMC colleagues (including Jennifer O’Neill, RN of the Specialty Care Clinic) on a recent paper published in Brain: Aberrant occipital dynamics differentiate HIV-infected patients with and without cognitive impairment.

Dr. James Lawler  (former White House Homeland Security Council biodefense policy director) was recently called upon to share his expertise pertaining to Biosecurity at the Blue Ribbon Study Panel on Biodefense, where he cautioned that we are unprepared for biological threats that may affect our country and the world.  He called for a new paradigm of innovation to prepare ourselves for future threats. A video of his testimony can be found here.

What a terrific group of talented and accomplished individuals.  Kudos to our faculty and staff for their continued hard work and dedication to advancing academic Infectious Diseases!

EMET Student Profile – Kevin Hanna, M1

Tell us about the position you are starting? I am a first-year medical student who is beginning the four year Enhanced Medical Education Track (EMET) program with a focus in HIV medicine. The program includes opportunities for preceptorships, seminars, volunteering, and research in HIV medicine culminating in a capstone research project and poster or conference presentation.

Background: I grew up in Bellevue, Nebraska and graduated from Bellevue West High School. I completed my undergraduate education at the University of Nebraska-Lincoln, with a Bachelor of Science degree in Microbiology. When I’m not studying, I love to read and run long distance races.

Why UNMC? Being a Nebraska native, I have always been interested in UNMC as an avenue to be at the center of patient care in Nebraska. When I was in high school, I participated in one of the inaugural classes of the UNMC High School Alliance, where I took Anatomy, Public Health, and Clinical Microbiology courses that piqued my interest in medicine and population health. These experiences drove me to pursue an undergraduate degree in Microbiology. This program helped me fall in love with the university, and I always hoped I would be able to come back for medical school. Additionally, I was very driven to the unique academic and clinical opportunities Nebraska Medicine provides, and am excited to be a part of the premier health system in the region.

What about ID and HIV medicine makes you excited?  I am drawn to the inherent detective work involved with Infectious Disease, and it makes me excited to use aspects of many different disciplines to solve complex, multi-system disease processes. My experiences in my undergraduate education have developed a passion for understanding the biological processes that drive diseases caused by microbial pathogens, and I am interested in tailoring treatment regimens to fight diseases caused by specific pathogens. I am especially excited to participate in this EMET, because I think HIV medicine combines infectious disease, population health, social determinants of health, and pharmacological breakthroughs in very exciting ways. I am excited to not only learn more about what it means to be an infectious disease physician, but also learn how to be a better physician through nuanced and rewarding patient interactions.

We wish Kevin the best of luck over the next several years during his journey with us as part of the HIV EMET! More information about the EMET program can be found here.

Pharm to Exam Table: Monoclonal Antibodies Make Their Way into HIV Treatment

Pharm to Exam Table: Clinical Pharmacology/Antimicrobial Updates – Trogarzo® (ibalizumab-uiyk), a new monoclonal antibody treatment approved for multi-drug resistant HIV-1

 On March 6th 2018, the Food and Drug Administration approved a new monoclonal antibody called ibalizumab-uiyk, marketed under the tradename Trogarzo®. Ibalizumab-uiyk (IBA) is an intravenous treatment administered every two weeks. It is intended for use in combination with other antiretrovirals (in an optimized background regimen), for the treatment of HIV-1 infection in heavily treatment-experienced adults with multidrug resistant HIV-1 infection, failing their current antiretroviral regimen.(1)

IBA is a humanized long-acting IgG4 monoclonal antibody that prevents attachment of the HIV-1 molecule to CD4+ T cells by changing the conformation of the CD4+ T cell receptor while preserving the function of the cell.  These functions classify IBA as an entry inhibitor.(1,3,4) Other previous entry inhibitors are enfurvitide (fusion inhibitor) and maraviroc (CCR5 antagonist). 

The FDA approval was based on results of study TMB-301 (N=40), an open-label study that investigated the antiviral activity and safety of IBA when administered with an optimized background regimen (OBR) in treatment-experienced patients with multi-drug resistant HIV-1. The study followed patients prospectively over 24 weeks after dosing them with IBA and their OBR.  At day 14, 83% of patients achieved at least a 0.5 log10 (roughly 70%) viral load reduction from baseline seven days after receiving the IBA loading dose. By week 25, the mean change from baseline viral load was -1.6 log10 with 55% of participants having a ≥1 log10 reduction in viral load. The most common drug-related adverse reactions (incidence ≥ 5%) were diarrhea (8%), dizziness (8%), nausea (5%) and rash (5%). Serious adverse events were reported in 23% (9/40) of participants and of these only one was considered drug-related (immune reconstitution inflammatory syndrome, IRIS).(1,2,4)

IBA is the first monoclonal antibody entry  inhibitor approved for HIV infection. Given its unique properties, tolerable safety profile, lack of drug-drug interactions or antiretroviral cross-resistance, IBA offers an attractive antiretroviral option for adjunct treatment of multi-drug resistant HIV-1 infection in combination with an Optimized Background Regimen.

References
1 Trogarzo ® [package insert]. TaiMed Biologics USA Corp., Irvine, California; 2018 
2 TaiMed Biologics Inc. Ibalizumab Plus Optimized Background Regimen in Patient With Multi-Drug Resistant HIV. Available from: https://clinicaltrials.gov/ct2/show/NCT02475629
3 Iacob S A, Iacob D G. Ibalizumab targeting CD4 receptors, an emerging molecule in HIV therapy[J]. Frontiers in microbiology, 2017, 8: 2323.
4 Lewis S et al. Long-acting ibalizumab in patients with multi-drug resistant hiv-1: a 24-week study. CROI, 2017 (Poster).

Images courtesy the Department of Health and Human Services AidsInfo website HIV/AIDS glossary on CCR5 Antagonists and Fusion Inhibitors.

Thanks to Chao Fu, UNMC PharmD candidate 2018 for providing concept for content.

Tune into this AMAZING Podcast : The Hot Zone: Biocontainment with Dr. Hewlett

 

Dr. Angela Hewlett recently was interviewed via podcast for a Travel Medicine show regarding biocontainment, including how to treat and handle highly infectious agents(yes, including Ebola). The blog posts include everything from what biocontainment is to worse case scenarios and other unique aspects of preparing for, and providing care for, people with these types of infections. The namesake for this podcast is a book regarding origins of the Ebola virus (this link is informational only, there is no benefit, financial or otherwise, to Dr. Hewlett or anyone involved with this blog post in regards to sales or sharing of this book).

You can access this podcast at: http://travelmedicinepodcast.squarespace.com/

 

Interested in learning more about Biocontainment?

Check out our the National Ebola Training and Education Center and the Nebraska Medicine Biocontainment Unit.

 


 

Nebraska Antimicrobial Stewardship Summit: A Step Forward in Fighting Antibiotic Resistance

The CDC estimates 30% of all antibiotics prescribed in outpatient setting in the US are unnecessary. Similarly 30% of antibiotics used in hospitals are estimated to be unnecessary or incorrectly prescribed. Inappropriate antibiotic prescribing in long-term care facilities have been found to be even higher in some studies (up to 75%). Improving antibiotic use is essential in the fight against antibiotic resistance. In the US, more than 2 million illnesses are caused by antibiotic resistant bacteria, leading to 23,000 deaths annually. Antibiotic use is also strongly associated with C. difficile infection which is another major public health threat. C. difficile infections are responsible for 250,000 illnesses requiring hospitalization or affecting already hospitalized patients and leads to 14,000 deaths each year in the US.

Antibiotic use in Nebraska is reported to be higher than the national average. Prescribing providers and healthcare institutions in Nebraska realize the need to pay attention to this important issue. Our colleagues at Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) with the support of Nebraska DHHS Healthcare Associated Infections (HAI) prevention team have been working with various healthcare facilities across Nebraska to improve antibiotic prescribing. There are many other organizations in the state collaborating with the Nebraska DHHS HAI team and Nebraska ASAP for the same goal. It is quite evident that healthcare facilities and prescribing providers are on-board in promoting appropriate antibiotic use in the state and developing antimicrobial stewardship programs (ASP) in their facilities. However, they need some support and guidance on best implementation strategies and effective use of the resources.

In order to meet the needs of healthcare facilities and prescribing providers in the state, Nebraska DHHS HAI team and Nebraska ASAP partnered with various local and regional organizations to organize a summit on antimicrobial stewardship. Nebraska Antimicrobial Stewardship Summit will be held on Friday June 1, 2018 in La Vista, NE. Many well known national and regional subject matter experts will be speaking at the summit. They will describe the rationales for developing ASP across the healthcare continuum. They will also outline simple strategies for ASP implementation in a variety of healthcare settings and share available resources to facilitate the process. There will be a networking session during the lunch, where attendees can find out how various organizations in the state can help them successfully implement ASP in their facilities.

The Nebraska Antimicrobial Stewardship Summit will be very helpful for any healthcare workers who are thinking about or already working on promoting appropriate antibiotic prescribing at their healthcare facility. Join us in the fight against antibiotic resistance! Register for the Summit at https://www.unmc.edu/cce/catalog/clinicmed/ne-as-summit/index.html. Follow @UNMC_ID on twitter for updates on #NebStewardSummit2018.

 

Content provided by Dr. M Salman Ashraf, Associate Professor, Division of Infectious Diseases, Department of Internal Medicine, Co-Medical Director, Nebraska Antimicrobial Stewardship Assessment and Promotion Program; Medical Director, Nebraska Infection Control Assessment and Promotion Program

 

Precious Davis, BSN, MSN on Why I Love ID

Why I Love ID:

“Before beginning nursing school, I always had a strong desire to give back to my community by educating and bringing awareness to the high STD rates in Douglas County. Throughout my career, I encountered some setbacks because of lack of enough work or educational experience to work in the field. While finishing my Masters Degree earlier this year, an HIV Case Management position became available, I jumped at it. Lo and behold, here I am today at the Specialty Care Clinic!  I am now able to collaborate with organizations within the community on patients referred to our clinic. What I love most about ID is being able to share my own personal experiences with patients that are receiving STD treatment and those from my community that need encouragement and reinforcement of compliance.”

-Precious Davis, BSN, MSN

See more about UNMC ID here.


 

Going Global for Biopreparedness – International Workshop on High-Level Isolation

Preparedness for outbreaks of infectious diseases is a critical, global issue, and several physicians from the UNMC Division of Infectious Diseases and other team members from the Nebraska Biocontainment Unit organized and participated in the International Workshop on High-Level Isolation in late April  The conference, which was held at the National Institutes of Health (NIH), was hosted by the National Ebola Training and Education Center (NETEC), Johns Hopkins Center for Health Security, National Institutes of Health, Centers for Disease Control (CDC) and the Assistant Secretary for Preparedness and Response (ASPR).

International Workshop on High Level Isolation participants, representing 14 countries around the world

Representatives from high-level isolation units from 14 countries around the world convened to share experiences and discuss issues like high level isolation unit design, clinical care and personal protective equipment in an interactive forum.   This international collaboration provided opportunities for the sharing of information and networking that are of utmost importance to enhance global preparedness for highly hazardous communicable diseases.

Getting ready to learn during the meeting.

To learn more about the Nebraska Biocontainment Unit, visit www.nebraskamed.com/biocontainment

To learn more about the National Ebola Training and Education Center, visit www.NETEC.org

 

 


 

Happy Administrative Professionals Day!

If you work in an office at all, chances are you have come into contact with an Administrative Professional.  The impact of an Administrative Professional on their office team has been compared to glue or paperclips that keep the office together. Our Administrative Professionals are an integral part of our group here at UNMC ID.  Sure, they help with things like setting up meetings, lectures, organizing receipts and appointments; but the best part of our people here are the intangibles. These individuals are so well integrated into our daily routines that it can be easy to take them for granted, but if they are absent for some reason, it becomes more obvious to us how much we rely on them for our days to go smoothly. In addition to the administrative duties, our Administrative Professionals are like family. They routinely visit our faculty and fellows to say hi, to check in with us to make sure we are staying sane, help new faculty and staff get acclimated, organize collections of food and money to help our colleagues in the division during difficult times, celebrate our birthdays and achievements, and give hugs or hold our hands when we have losses or disappointments. They do all of these things without ever asking for recognition.

It is sometimes easy to get caught up in the moment of “special days”, and it is wonderful to lavish gifts and flowers on those who tirelessly strive to preserve our routines at  work.  However, we should all develop the habit of thanking our Administrative Professionals EVERY DAY, not just on this one day, because if you really think about it, without them, our worlds at work might truly fall apart.

To our own Administrative Professionals in the UNMC ID Division: Deanna Hansen, Deborah Justesen, Sandy Nelson, Jonathan Nguyen and Regina Shumaker, and to ALL Administrative Professionals in every professional setting: THANK YOU for all you do! 

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