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Alexander Tan Limkakeng Jr.

Professor of Emergency Medicine
Emergency Medicine
2301 Erwin Road Box 3096, Durham, NC 27710
2301 Erwin Road, Box 3096, Durham, NC 27710

Selected Publications


Acute coronary syndrome prevalence and outcomes in a Tanzanian emergency department: Results from a prospective surveillance study.

Journal Article Afr J Emerg Med · March 2025 BACKGROUND: Preliminary data suggests that the burden of acute coronary syndrome (ACS) is high in Tanzania. After efforts to improve ACS care, we sought to describe ACS diagnosis rates, care processes, and outcomes in a Tanzanian Emergency Department (ED). ... Full text Link to item Cite

2023 Society for Academic Emergency Medicine Consensus Conference on Precision Emergency Medicine: Development of a policy-relevant, patient-centered research agenda.

Journal Article Acad Emerg Med · August 2024 OBJECTIVES: Precision medicine is data-driven health care tailored to individual patients based on their unique attributes, including biologic profiles, disease expressions, local environments, and socioeconomic conditions. Emergency medicine (EM) has been ... Full text Link to item Cite

Evaluating the performance of the HEART score in a Tanzanian emergency department.

Journal Article Acad Emerg Med · April 2024 OBJECTIVE: The HEART score successfully risk stratifies emergency department (ED) patients with chest pain in high-income settings. However, this tool has not been validated in low-income countries. METHODS: This is a secondary analysis of a prospective ob ... Full text Link to item Cite

RobOCTNet: Robotics and Deep Learning for Referable Posterior Segment Pathology Detection in an Emergency Department Population.

Journal Article Transl Vis Sci Technol · March 1, 2024 PURPOSE: To evaluate the diagnostic performance of a robotically aligned optical coherence tomography (RAOCT) system coupled with a deep learning model in detecting referable posterior segment pathology in OCT images of emergency department patients. METHO ... Full text Link to item Cite

Adapting an Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Co-Design of the MIMIC Intervention.

Journal Article Ann Glob Health · 2024 BACKGROUND: Uptake of evidence-based care for acute myocardial infarction (AMI) is suboptimal in Tanzania, but there are currently no published interventions to improve AMI care in sub-Saharan Africa. OBJECTIVES: Co-design a quality improvement interventio ... Full text Link to item Cite

Provider attitudes towards quality improvement for myocardial infarction care in northern Tanzania.

Journal Article PLOS Glob Public Health · 2024 INTRODUCTION: Myocardial Infarction (MI) is a leading cause of death worldwide. In high income countries, quality improvement strategies have played an important role in increasing uptake of evidence-based MI care and improving MI outcomes. The incidence o ... Full text Link to item Cite

Fixing the leaky physician-scientist pipeline: Integrated-dedicated research period programs in emergency medicine.

Journal Article AEM Educ Train · December 2023 Emergency physicians (EPs) are well positioned to perform medical research. EPs are exposed to a wide range of disease types, medical specialties, and treatment modalities. Furthermore, emergency medicine (EM) serves as the safety net for the U.S. health c ... Full text Link to item Cite

Robotic Optical Coherence Tomography Retinal Imaging for Emergency Department Patients: A Pilot Study for Emergency Physicians' Diagnostic Performance.

Journal Article Ann Emerg Med · April 2023 STUDY OBJECTIVE: To evaluate the diagnostic performance of emergency physicians' interpretation of robotically acquired retinal optical coherence tomography images for detecting posterior eye abnormalities in patients seen in the emergency department (ED). ... Full text Link to item Cite

Six-month blood pressure and glucose control among HIV-infected adults with elevated blood pressure and hyperglycemia in northern Tanzania: A prospective observational study.

Journal Article PLoS One · 2023 BACKGROUND: People with HIV in sub-Saharan Africa are increasingly developing age-related comorbidities. The purpose of this prospective observational study was to describe 6-month outcomes among Tanzanians with HIV and elevated blood pressure or hyperglyc ... Full text Link to item Cite

Longitudinal ECG changes among adults with HIV in Tanzania: A prospective cohort study.

Journal Article PLOS Glob Public Health · 2023 The prevalence of cardiovascular disease (CVD) is rising among people with HIV (PWH) in sub-Saharan Africa (SSA). Despite the utility of the electrocardiogram (ECG) in screening for CVD, there is limited data regarding longitudinal ECG changes among PWH in ... Full text Link to item Cite

Sepsis with liver dysfunction and coagulopathy predicts an inflammatory pattern of macrophage activation

Journal Article Intensive Care Medicine Experimental · December 1, 2022 Background: Interleukin-1 receptor antagonists can reduce mortality in septic shock patients with hepatobiliary dysfunction and disseminated intravascular coagulation (HBD + DIC), an organ failure pattern with inflammatory features consistent with macropha ... Full text Cite

Outcomes in ED patients with non-specific ECG findings and low high-sensitivity troponin.

Journal Article J Am Coll Emerg Physicians Open · December 2022 BACKGROUND: Although some emergency department risk stratification tools consider non-specific ECG findings as an aid in disposition decisions, their clinical value in patients with an initially low high-sensitivity cardiac troponin I (hsTnI) is unclear. O ... Full text Open Access Link to item Cite

Acupuncture for acute musculoskeletal pain management in the emergency department and continuity clinic: a protocol for an adaptive pragmatic randomised controlled trial.

Journal Article BMJ Open · September 23, 2022 INTRODUCTION: Chronic musculoskeletal pain causes a significant burden on health and quality of life and may result from inadequate treatment of acute musculoskeletal pain. The emergency department (ED) represents a novel setting in which to test non-pharm ... Full text Link to item Cite

Stress-Delta B-Type Natriuretic Peptide Does Not Exclude ACS in the ED.

Journal Article J Appl Lab Med · September 1, 2022 Featured Publication BACKGROUND: There are many detectable changes in circulating biomarkers in the setting of myocardial ischemia. We hypothesize that there are associated changes in circulating B-type natriuretic peptide (BNP) level after stress-induced myocardial ischemia, ... Full text Link to item Cite

Predictors of Stress-Delta High-Sensitivity Troponin T in Emergency Department Patients Undergoing Stress Testing.

Journal Article Cureus · September 2022 Featured Publication Background and objective Elevations in high-sensitivity troponin T (hs-TnT) are frequently observed following extreme physical exercise. In light of this, we sought to determine whether specific clinical characteristics are associated with this phenomenon ... Full text Open Access Link to item Cite

Direct vs Video Laryngoscopy for Difficult Airway Patients in the Emergency Department: A National Emergency Airway Registry Study.

Journal Article West J Emerg Med · August 19, 2022 INTRODUCTION: Previous studies suggest improved intubation success using video laryngoscopy (VL) vs direct laryngoscopy (DL), yet recent randomized trials have not shown clear benefit of one method over the other. These studies, however, have generally exc ... Full text Open Access Link to item Cite

Prognosis is worse with elevated cardiac troponin in nonacute coronary syndrome compared with acute coronary syndrome.

Journal Article Coron Artery Dis · August 1, 2022 BACKGROUND: Cardiac troponin (cTn) can be elevated in many patients presenting to the emergency department (ED) with chest pain but without a diagnosis of acute coronary syndrome (ACS). We compared the prognostic significance of cTn in these different popu ... Full text Link to item Cite

A precision medicine approach to stress testing using metabolomics and microribonucleic acids.

Journal Article Per Med · July 2022 Featured Publication Both transcriptomics and metabolomics hold promise for identifying acute coronary syndrome (ACS) but they have not been used in combination, nor have dynamic changes in levels been assessed as a diagnostic tool. We assessed integrated analysis of periphera ... Full text Link to item Cite