Researchers at the USF Health Morsani College of Medicine were awarded $5.6 million of expected funds for a 4-year study from the U.S. Department of Defense to examine why many people with Friedreich’s Ataxia (FA) go on to also develop heart disease, a major cause of death for those with FA.

Principal investigator for the USF study is Thomas McDonald, MD, professor in the Department of Internal Medicine (Division of Cardiology) and the Department of Molecular Pharmacology and Physiology in the USF Health Morsani College of Medicine. Dr. McDonald is also a researcher in the USF Health Heart Institute and director of the USF Health Cardiogenetics Clinic.

“We still don’t have a full understanding of the genetic mutation for Friedrich’s ataxia to determine why so many patients go on to get heart disease – we need to know,” Dr. McDonald said. “The physiology is not well characterized. This study will help us gain a better understanding of the basic mechanisms of the gene that carries FA, and help identify clinical predictors of the FA-associated heart disease.”

The new study dovetails with current work taking place in Dr. McDonald’s lab, including an R56 grant from the National Institutes of Health, which focuses on the fundamental mechanisms of LMNA-associated heart disease passed from one generation to the next — and what can be done to help prevent disease and its consequences.

This FA-heart disease study will follow FA patients and their parents over four years, and will involve careful clinical monitoring of heart health, examination of biomarkers, whole genome sequencing, stem cell modeling of heart tissue, and mitochondrial function studies.

From left, Dr. Kami Kim, Dr. Aarti Patel, Dr. Thomas McDonald, and Dr. Theresa Zesiewicz. Not pictured is Sami Noujaim, PhD.

Spearheading the work in the DoD study is a multidisciplinary team of USF Health experts representing cardiology, genetics, neurology, molecular pharmacology, cardiac electrophysiology and predictive modeling. The diverse expertise will help distinguish the clinical, genetic, and biological factors that contribute to cardiac disease in FA patients. Data from FA families and basic science models will be integrated with clinical data to identify unique factors in the heart that influence the cardiac phenotype and separate cardiac-specific traits from those influencing the neurological phenotype.

“Study results could lead to tools used in patient care settings to identify those FA families most at risk for cardiomyopathy and allow for potential intervention and treatment that could help delay onset of the heart disease,” Dr. McDonald said.

The USF Health interdisciplinary team for the study includes:

• Thomas McDonald, MD: clinical cardiology, molecular pharmacology and cardiogenetics (Division of Cardiology, Department of Internal Medicine, MCOM)
• Aarti Patel, MD: neurocardiogenetics and cardiac imaging (Division of Cardiology, Department of Internal Medicine, MCOM)
• Sami Noujaim, PhD: molecular pharmacology and cardiac electrophysiology (Department of Molecular Pharmacology and Physiology, MCOM)
• Kami Kim, MD: machine learning and clinical predictive modeling (Division of Infectious Diseases, Department of Internal Medicine, MCOM; Center for Global Health Infectious Diseases Research, COPH)
• Theresa Zesiewicz, MD, clinical neurology (Department of Neurology, MCOM)

Dr. Zesiewicz, professor in MCOM and director of the USF Health Ataxia Research Center, has specialized in clinical research and patient care for ataxias and other movement disorders’ for more than 20 years and is recognized as an international expert and leader in the field of hereditary ataxias. Her movement disorders clinic supports the evaluation of over 3,000 patients per year, likely the busiest in the world.

“Dr. Zesiewicz will play a vital role in recruiting research participant and in overseeing neurological assessments of patients as they are longitudinally followed in this study,” Dr. McDonald said.

The funding for the study came from the DoD through its Congressional Directed Medical Research Programs (CDMRP), a section of DoD that funds novel approaches to biomedical research. Link: https://cdmrp.health.mil/

The team will begin recruiting study participants next month.

Photo by Ryan Rossy, USF Health Communications

Irene Davis, PhD, PT, FACSM, FAPTA, FASB, professor in the USF Health School of Physical Therapy and Rehabilitation Sciences, is trying to understand the intricate relationship between lower extremity mechanics and overuse injuries in runners. With a focus on transforming the way runners experience pain and preventing injury, Dr. Davis and her team are researching gait retraining for injury prevention. 

Subject crossing the force plate at a constant velocity to test the three-dimensional components of force being produced on their joints.

At the heart of their research is a force plate used at the center of an elongated runway. This allows individuals to simulate a complete running cycle, starting from acceleration, and crossing the force plate at a consistent velocity. The force plate captures not only vertical forces but also forces in all three dimensions, offering a clearer picture of the intricate nature of the forces exerted when landing. This three-dimensional analysis provides a comprehensive understanding of how alignment and mechanics contribute to the risk of injury.

Reflective markers attached to a subject’s body which supply data with a multi-dimensional perspective on joint movement. Essential for understanding the mechanics involved in running.

To access this data, the research team attaches reflective markers to the subjects’ bodies, which are then tracked by multiple cameras. These complex algorithms decipher the markers’ movements, enabling the researchers to see the angles at the ankle, knee, and hip joints. This approach supplies a multi-dimensional perspective on joint movement, essential for understanding the mechanics involved in running.

The integration of force plate data and marker tracking empowers the team to calculate joint loads and torques, giving a complete picture of the forces experienced by various joints during a runner’s gait cycle. This holistic approach enables Dr. Davis and her team to identify problematic mechanics and design interventions that could alleviate pain and reduce the risk of injury. 

By applying their findings, her team is pioneering an innovative approach to runner rehabilitation. Through a series of sessions involving real-time feedback and targeted practice, the research team has started receiving results. A notable example is a study focused on addressing knee pain, in which participants underwent a tailored gait retraining program. Participants experienced improvements in their alignment and mechanics, easing the persistent pain that they have dealt with for years. 

This groundbreaking research challenges the traditional notion that gait patterns are fixed and unalterable. By bridging the gap between scientific understanding and medical practice, Dr. Davis and her team have proven that gait retraining is not only possible but also effective in alleviating pain and preventing future injuries. The success of their interventions underscores the transformative potential of multidimensional biomechanical analysis in sports medicine. 

The researcher is analyzing data provided by the force plate.

In a field where innovation meets application, Dr. Davis and her team are revolutionizing the way we think about running mechanics and their impact on injuries. This has not only raised awareness but also instilled hope for countless runners who want to run free of pain. Dr. Davis hopes that science and medicine can work hand in hand to reshape runners’ lives.

“We hope our clinic and our research will offer injured runners a solution so they are able to continue to run pain-free,” Dr. Davis said. “We really have pioneered this idea of retraining gait patterns.”  

Story, photos, and video by Ryan Rossy.

The Esophageal String Test is a brand-new option, and USF Health is one of only three sites in the country offering it.

Racha Khalaf, MD, assistant professor and chief of Pediatric Gastroenterology at the USF Health Morsani College of Medicine, is using a less invasive method to monitor a condition known as Eosinophilic Esophagitis (EoE). The chronic disease is characterized by white blood cells called eosinophils infiltrating the esophagus and causing inflammation, which can lead to difficulty swallowing or food getting caught in the swallowing tube known as the esophagus.

“EoE patients have a migration of eosinophils to the esophagus, causing symptoms like vomiting and difficulty eating,” Dr. Khalaf said. “In children, it can even lead to difficulty with growth.”

Dr. Racha Khalaf.

Traditionally, after diagnosing the condition, physicians monitor EoE using a sedated procedure known as an endoscopy, in which the doctor snakes a tube containing a tiny camera down the patient’s throat to view the esophageal lining. The procedure requires anesthesia in children and can have risks including pain and discomfort. But Dr. Khalaf said she uses the Esophageal String Test, which provides her the information she needs to determine a treatment plan without the same level of discomfort and an improved risk profile.

The Esophageal String Test is a brand-new option, and USF Health is one of only three sites in the country offering it.

During the test, the patient swallows a small pill containing a flexible string. The end of the string is taped to the cheek and the string remains in place for one hour and collects esophageal secretions that are then examined for the presence of inflammation caused by eosinophils.

Esophageal String Test with capsule.

For 9-year-old Shark Smith, who has been diagnosed with EoE, the Esophageal String Test is a welcome alternative to regular endoscopies. “It’s better because I don’t have to get put under with anesthesia,” he said. “And it doesn’t take that long. It only takes an hour.”

Shark’s mother, Jennifer Smith, shared his sentiment. She said, “He’s been scoped, I think, seven times since he was two years old.” The diagnosis of EoE came accidentally when Shark swallowed a penny, leading to his first endoscopy. “We never had any symptoms,” she said.

The Esophageal String Test proved beneficial when Shark’s treatment was not yielding the desired results. “It told us that we’re pretty much taking this medication for no reason now,” Jennifer Smith said. “So, we have to change our treatment plan.” They came to Dr. Khalaf, seeking other options apart from scoping every six to 12 months.

“It’s easier on him; it’s easier on the mom,” Jennifer Smith noted. Shark recommends patients bring something to keep themselves entertained during the procedure, such as a book or an electronic device. Both mother and son praise Dr. Khalaf and the string test. “Dr. Khalaf is amazing,” Shark said. “And if anybody has the chance to do this, I would definitely recommend it over scoping.”

“We’re just really happy,” Jennifer Smith said. “We’re happy with Dr. Khalaf. We’re happy with the test.”

Story, video and images by Allison Long, USF Health Office of Communications.

Tampa General Hospital continues to be the best hospital in the Tampa Bay area, as today’s release of the 2023-24 rankings by U.S. News & World Report show.

Today’s U.S. News announcement also recognized 11 Tampa General specialties for their strong national reputation and performance, including six in the nation’s top 50 and three in the top 20. Many of the 11 specialties are led or co-led by USF Health faculty physicians.

“Tampa General’s strong showing in this year’s rankings is a testament to the compassionate care and clinical expertise of our primary teaching partner,” said Dr. Charles J. Lockwood, executive vice president of USF Health and dean of USF Health Morsani College of Medicine.

“I’m so proud of our physicians and the leadership they have provided in propelling so many specialties to be among the best in the nation. These rankings translate into saving patients’ lives across Tampa Bay and beyond.”

Dr. Lockwood is also the executive vice president and chief academic officer of Tampa General Hospital.

The six specialties ranked among the top 50 in the nation are:

• Obstetrics and Gynecology – ranked #9 in the U.S. and #1 in Florida
• Gastroenterology and GI Surgery – ranked #19 in the U.S. and #1 in Florida
• Diabetes & Endocrinology – ranked #18 in the U.S. and #2 in Florida
• Ear, Nose & Throat – ranked #39 in the U.S. and #2 in Florida
• Orthopedics – ranked #30 in the U.S. and #2 in Florida
• Urology – ranked #49 in the U.S. and #2 in Florida

In addition, five more specialties were recognized as “high performing” and among the top 10% in the nation:

• Cancer
• Cardiology & Heart Surgery
• Geriatrics
• Neurology & Neurosurgery
• Pulmonology & Lung Surgery

Family medicine, considered the oldest and broadest subspecialty of medicine, plays a critical role in maintaining community health and access to care. In fact, 90 percent of primary care doctors are family physicians, providing care of a wide range of ailments and conditions from newborns to seniors.

Eric Coris, MD

Eric Coris, MD, professor and chair of the Department of Family Medicine in the USF Health Morsani College of Medicine, said that family physicians significantly enhance overall health outcomes, particularly for patients from underserved populations.

Aspiring doctors echo this sentiment. Kirtan Patel, a fourth year Morsani College of Medicine student, emphasizes his commitment to the community: “Free clinic work is crucial. It provides a place for the underinsured and uninsured in the community to receive medical care.”

However, the United States – and especially a state like Florida — faces a severe shortage of primary care doctors, posing a serious healthcare challenge. The Association of American Medical Colleges estimates that the country will need an additional 55,000 primary care physicians over the next 10 years to keep up with demand.

To counteract this shortage, USF Health and Tampa General Hospital are joining forces to offer a Family Medicine residency position starting in July 2025. Dr. Coris underlined the necessity of these residency programs, saying, “These programs play a pivotal role in strengthening the health care infrastructure, nurturing a new generation of physicians and facilitating enhanced patient care.”

Patel added, “Family Medicine is the specialty geared toward primary care and preventative care.”

Kirtan Patel studies recently at the USF Health Morsani College of Medicine in downtown Tampa.

Family medicine training includes care for pediatric patients, adults, and pregnant women. The field often attracts medical students and residents passionate about serving their communities, which is key in addressing healthcare disparities and enhancing community health.

“Making a difference in the community is a powerful feeling,” Patel said. “The more family medicine physicians we can train and graduate, the better for any community as a whole.”

The goal remains clear: cultivate family medicine physicians through effective residency programs, enhancing access to care and reducing healthcare disparities.

The family medicine residency program will be a key addition to the nation’s fastest-rising medical school in primary care over the past decade, as recognized by U.S. News & World Report Academic Insights.

Using a comprehensive hearing intervention designed, tested, and implemented by researchers at the University of South Florida, the multi-site ACHIEVE study examined the efficacy of hearing aids for reducing long-term cognitive decline in older adults.

Results from the largest randomized, controlled clinical trial testing the efficacy of hearing aids for reducing long-term cognitive decline in older adults were published July 18, 2023, in the journal Lancet, as well as reported for the first time at the Alzheimer’s Association International Conference® (AAIC®) 2023, held the same day, in Amsterdam, Netherlands.

Called the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, the multisite study found that, in older adults at increased risk for cognitive decline, hearing intervention slowed down loss of thinking and memory abilities by 48% over three years.

While the results were negative in the total study population, the hearing intervention did slow cognitive decline by 48% in a study subset of older adults with mild to moderate hearing loss who are participating in an ongoing observational study of heart health. Investigators believe that the effect of the hearing intervention on reducing cognitive decline was only apparent in the group of participants from the heart health study because this group had nearly a 3-fold faster rate of cognitive decline over the study period than the healthy volunteers that enrolled in the trial. That much faster rate of decline allowed researchers to see the beneficial effects of hearing intervention on reducing this decline within the limited 3-year period of the study.

“The hearing intervention had a significant effect on reducing cognitive change within three years in the population of older adults in the study who are at increased risk for cognitive decline,” said Frank Lin, MD, PhD, of Johns Hopkins University School of Medicine and Bloomberg School of Public Health, and co-principal investigator of the ACHIEVE study. “Hearing loss is very treatable in later life, which makes it an important public health target to reduce risk of cognitive decline and dementia, along with other dementia risk factors such as less education in early life, high blood pressure, social isolation and physical inactivity.”

The overall ACHIEVE study was led by researchers at Johns Hopkins and seven additional contributing institutions. A team of researchers from USF led the hearing intervention provided in the study. From the Department of Communication Sciences and Disorders in the USF College of Behavioral and Community Sciences, Theresa H. Chisolm, PhD, professor and vice provost for Strategic Planning, Performance and Accountability, and Michelle Arnold AuD, PhD, assistant professor, collaborated with Victoria Sanchez, AuD, PhD, assistant professor in the Department of Otolaryngology in the USF Health Morsani College of Medicine.

In addition to designing the hearing intervention, the USF team also trained the study audiologists and continuously monitored the hearing intervention that was provided in the overall study.

“The ACHIEVE Study is evidence that auditory rehabilitation, including the use of hearing aids, in older adults who had more risk factors for cognitive decline slowed the rate of cognitive decline,” said USF Health’s Dr. Sanchez. “Important risk factors for cognitive decline and dementia that could be potentially addressed to help reduce dementia include hearing loss, less education in early life, smoking, diabetes, high blood pressure, social isolation, and physical inactivity. Addressing hearing loss is one way we could reduce the increase rate of older adults living with dementia.”

Established research shows that loss of hearing can increase a person’s likelihood of cognitive decline, she said, adding that further research is needed.

“Our main trial results shared today are exciting and informative, but much more research is still needed,” Dr. Sanchez said. “Our team of multi-institution investigators are continuing to follow all participants in the ACHIEVE study beyond three years to look at longer term effects of hearing intervention on cognition and other outcomes.”

This foundational work can also help guide policymakers, she said.

“Our results will hopefully create policy changes because in many parts of the world we need improved affordable access and insurance coverage for hearing treatment/intervention,” Dr. Sanchez said. “This does not mean just a hearing aid, as hearing intervention consists of two components. First are hearing aids and related hearing technologies, and second are the diagnostic and hearing care support services of an audiologist to guide the individual in using these hearing technologies to hear and communicate optimally.

“We recommend that people who have concerns about their hearing and their risk factors for cognitive decline discuss these concerns with their doctor and be seen by an audiologist to address their hearing and communication needs.”

The ACHIEVE study is a randomized trial of older adults aged 70-84 with untreated hearing loss who were free from substantial cognitive impairment, conducted at four study sites in the United States, and 977 total participants were recruited from two study populations: 238 adults participating in the Atherosclerosis Risk in Communities (ARIC) study, and 739 healthy community volunteers newly recruited to the study.

The complexities and nuances for successfully treating chronic sinusitis usually involves two medical specialists, an otolaryngologist-head and neck surgeon (also called an ENT) and an allergist/immunologist.

Patients with this condition usually see these two specialists in separate appointments.

Now USF Health is offering a merged clinic for patients with chronic sinusitis and related conditions where they will have one appointment with both an ENT and an allergist at the same time.

Farnaz Tabatabaian, MD, associate professor in the Department of Allergy and Immunology in the USF Health Morsani College of Medicine, and Mark Tabor, MD, associate professor in the Department of Otolaryngology Head and Neck Surgery in the USF Health Morsani College of Medicine, have combined their expertise and their clinics to form this new merged clinic.

The aim is to more effectively treat patients by being more efficient with the treatment plan, Dr. Tabatabaian said.

“We’re an academic institution so we see more complex conditions,” Dr. Tabatabaian said. “Bringing these two specialties into one clinic, one visit for the patient, makes incredible sense, not just for convenience but also for continuity of care and better outcomes. An ENT and an immunologist both in the room will better help meet the needs of patients experiencing the most complex sinusitis cases.”

Those with chronic sinusitis need the expertise of both an ENT and an allergist because they may need surgery to address the physical and structural problems, which the ENT will provide, and then also need allergy shots, antibiotics and, perhaps, biologics from the allergist to address the underlying immune and inflammatory response. Most patients will need both approaches but, as typically happens, the time between appointments allows the condition to return, causing patients to need further care and starting the cycle of treatments and procedures over again.

“Done separately, the condition isn’t fully treated, meaning patients may go back and forth with ENT and allergist appointments,” Dr. Tabor said. “The structural fix only lasts until the immune system flares up again and sinusitis returns, or the immune system is calmed and the barriers in the structure continue to limit and sinusitis returns. By addressing both structural and immune response at once, treating the two root causes together, patients will fare better for beating the return of sinusitis.”

“The therapies are available, but the collaborative environment in one clinical setting means we are offering precision medicine at its core,” Dr. Tabatabaian said. “Combining our clinics into one collaborative setting means we are taking great care of patients and also learning from each other as colleagues.”

The USF Health combined clinic is also a great educational opportunity for medical students, resident physicians and fellows. And for patients, the merged clinic also means greater access to clinical trials for new therapies.

Chronic rhinosinusitis is inflammation of the nasal and sinus linings, nasal blockage, rhinorrhea, facial pressure/pain and loss of sense of smell, and may include nasal polyps.

Patients seeking appointments at this new USF Health combined clinic will need to have a diagnosis of chronic sinusitis and have tried but not benefited from traditional therapies. Ask your physician about a referral to the clinic to see if your condition qualifies.

Moving an entire clinic can be a very daunting and cumbersome task, especially when you have to get it ready for patients only a few days later.  The staff and faculty of the USF Health Physical Therapy Center managed that process recently when they relocated the clinic to its new home.

Matt Lazinski, PT, DPT, OCS, associate professor and director of the clinic, and his team didn’t miss a beat when it came to patient care.  The team continued to see patients until noon June 16 and began packing the clinic at 1:00 p.m.  By 3:00 p.m., a moving company starting packing all of the therapy tables, and heavy machines.  The first load of machines arrived at their new home by 5:00 p.m. and the clinic team immediately began organizing the space.  Dr. Lazinski and his team worked through the weekend to make sure the clinic was ready to see patients by Monday.

Dr. Lazniski said there are some key upgrades that come with moving to a more modern space:

• A first-floor location means easier access for patients with mobility issues
• Bigger treatment rooms
• More efficient and functional space
• Televisions to assist in patient education
• Co-located with USF Health family medicine providers

“Moving over the weekend was for our patients so we aren’t canceling appointments,” Dr. Lazinski said. “My team has been great.  This has been a long time coming with a lot of starts and stops and they’ve been very patient throughout the process.  I can’t say enough good things about my team.”

The new clinic is located at 3500 E. Fletcher Ave. Suite 100 in the University Professional Center.

Additional photos:

As the day wanes, medical student volunteers with the USF Health Tampa Bay Street Medicine (TBSM) Refugee Clinic are inventorying medical supplies and vaccines before patients arrive for evening appointments.

“In the past six months our patient population doubled,” Azd Al-Mashal, MD, co-founder of the USF Health TBSM Refugee Clinic, said before the start of another busy Wednesday night.

The USF Health TBSM Refugee Clinic provides free medical care to refugees from all over the world, adults and children who now have a common bond of being refugees in the Tampa area. TBSM is a student-run organization dedicated to improving the health of vulnerable populations in our community. The TBSM Refugee Clinic offers medical provider visits, prescriptions, over-the-counter medications, labs, imaging, mental health services, preventative care and hygiene kits to refugees and asylum seekers who don’t have insurance. The clinic is held twice a month, evenings on the second and fourth Wednesday, at USF Health Carol and Frank Morsani Center for Advanced Healthcare.

“Ten years down the line, I definitely want to see Refugee Clinic continuing its incredible momentum of growth,” said Richa Bisht, MD, the former co-director of the USF Health TBSM Refugee Clinic.

To donate to the USF Health Tampa Bay Street Medicine and the Refugee Clinic, please visit giving.usf.edu

In recognition of World Voice Day on April 21, 2023, laryngologists and speech-language pathologists at the USF Health Voice Center hosted a unique and engaging event dedicated to helping performers maintain and enhance their voice health.

“World Voice Day is an opportunity to celebrate the voice, the instrument and how we use that in the world,” said Stephanie Watts, PhD, a clinical speech pathologist with the USF Health Voice Center.

The attendees benefited from a range of valuable experiences at the event, including:

• Free Vocal Cord Screenings: Participants received an assessment of their vocal cords, conducted by USF Health’s expert laryngologists and speech-language pathologists. This allowed attendees to gain insights into their vocal health and receive personalized recommendations.
• Vocal Seminar: Our USF Health experts led an informative seminar that discussed various aspects of voice health, including proper vocal techniques, vocal hygiene and the prevention and treatment of some common voice disorders.
• Laryngeal Karaoke: The session provided a fun and interactive activity that showcased the importance of healthy vocal practices while engaging in a spirited, entertaining environment.

“I am so proud of my team for putting this day together . . . when you bring the right people and the right team together, magical things happen,” said Yael Bensoussan, MD, a USF Health Laryngologist and the director of USF Health Voice Center. “I’m really excited that this will become a yearly event for World Voice Day to support our community.”

In recognition of World Voice Day, laryngologists and speech-language pathologists at the USF Health Voice Center hosted a unique and engaging event dedicated to supporting performers in maintaining and enhancing their voice health. Pictured are (left-right) USF Health laryngologists Yassmeen Abdel-Aty, MD, Voice Center Director, Yael Bensoussan, MD, and speech pathologists Megan Urbano, CCC-SLP and Stephanie Watts, PhD.