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Uhthoff Phenomenon, Sreelakshmi Panginikkod, Lokesh A.. Rukmangadachar 2019 University of Massachusetts Medical School

Uhthoff Phenomenon, Sreelakshmi Panginikkod, Lokesh A.. Rukmangadachar

Open Access Articles

Uhthoff's phenomenon (also known as Uhthoff sign or Uhthoff syndrome) is described as temporary, short-lived (less than 24 hours) and stereotyped worsening of neurological function among multiple sclerosis patients in response to increases in core body temperature. This phenomenon is named after Wilhelm Uhthoff, a German ophthalmologist who described it. In 1890, Uhthoff first described exercise-induced amblyopia in multiple sclerosis patients. In 1961, this phenomenon was given his surname, Uhthoff's Phenomenon (UP), by G. Ricklefs[1]. In four out of 100 MS patients, Uhthoff observed the appearance of reversible optic symptoms induced by an increase in body temperature ...


Aortoduodenal Fistula Forms From Primary Aortic Stump Graft In A Two-Time Multi-Visceral Transplant Patient With Presentation Of Gastrointestinal Bleed And Bowel Perforation: A Case Report, Brielle Corrente 2019 Duquesne University

Aortoduodenal Fistula Forms From Primary Aortic Stump Graft In A Two-Time Multi-Visceral Transplant Patient With Presentation Of Gastrointestinal Bleed And Bowel Perforation: A Case Report, Brielle Corrente

Graduate Student Research Symposium

Usually not diagnosed until open laparotomy, aortoduodenalfistulas (ADF) are one of the rarest complications of intestinal transplant surgery. With an incidence rate of only 0.04% at autopsy and only 250 documented cases since the early 1800’s, aortoduodenal fistulas are the most deadly complications of intestinal transplantation with a mortality rate of 100% without surgical intervention. A 39 year old, two-time multi-visceral transplant African American female patient suffered from a primary aortoduodenal fistula formation in a primary modified multi-visceral transplant aortic stump graft site. With emergency open laparotomy repair, revascularization of the secondary multi-visceral transplant was performed, saving the ...


Assessment Of The Potential Use Of Recombinant Baculovirus-Expressed Lassa Virus Nucleoprotein As A Serodiagnostic Antigen, Sahiba Grover 2019 Kansas State University Libraries

Assessment Of The Potential Use Of Recombinant Baculovirus-Expressed Lassa Virus Nucleoprotein As A Serodiagnostic Antigen, Sahiba Grover

Kansas State University Undergraduate Research Conference

Lassa virus is an arenavirus causing a disseminated systemic primary viral infection. This virus causes Lassa fever which is a viral hemorrhagic fever endemic in West Africa and is responsible for the deaths of thousands of people each year. There is a possibility for the Lassa virus to be introduced into the US and used as a biological weapon with the potential to harm a large-scale population. Because of increasing international travel, a sizeable burden from the disease, and its potential use for biological warfare, it is necessary to develop sensitive diagnostic assays to accurately detect virus infections and mitigate ...


Two Unique Cases Of X-Linked Scid: A Diagnostic Challenge In The Era Of Newborn Screening, Pooja Purswani, Anne Marie Comeau, Jaime E. Hale, Jolan E. Walter 2019 Johns Hopkins All Children's Hospital

Two Unique Cases Of X-Linked Scid: A Diagnostic Challenge In The Era Of Newborn Screening, Pooja Purswani, Anne Marie Comeau, Jaime E. Hale, Jolan E. Walter

Open Access Articles

In the era of newborn screening (NBS) for severe combined immunodeficiency (SCID) and the possibility of gene therapy (GT), it is important to link SCID phenotype to the underlying genetic disease. In western countries, X-linked interleukin 2 receptor gamma chain (IL2RG) and adenosine deaminase (ADA) deficiency SCID are two of the most common types of SCID and can be treated by GT. As a challenge, both IL2RG and ADA genes are highly polymorphic and a gene-based diagnosis may be difficult if the variant is of unknown significance or if it is located in non-coding areas of the genes that are ...


Engaging Emergency Department Patients In The Creation Of A Shared Decision-­Making Tool Regarding Ct Scanning In Kidney Stones: Challenges To Traditional Stakeholder Engagement, Elizabeth M. Schoenfeld, Connor J. Houghton, Pooja P. Patel, Leonora Merwin, Kathleen M. Mazor, Erik Hess, Charles Scales, Maggie Breslin, Peter K. Lindenauer 2019 University of Massachusetts Medical School

Engaging Emergency Department Patients In The Creation Of A Shared Decision-­Making Tool Regarding Ct Scanning In Kidney Stones: Challenges To Traditional Stakeholder Engagement, Elizabeth M. Schoenfeld, Connor J. Houghton, Pooja P. Patel, Leonora Merwin, Kathleen M. Mazor, Erik Hess, Charles Scales, Maggie Breslin, Peter K. Lindenauer

Kathleen M. Mazor

Background: Every year approximately 2 million patients are seen in US EDs for suspected renal colic, and the majority receive CT scans. The objective of our study was to develop a stakeholder-informed conversation aid to help clinicians use SDM regarding CT scanning in patients with suspected renal colic.

Methods: Using a published decision aid development framework, and under the direction of a multi-disciplinary Steering Committee, we engaged a diverse set of stakeholders via qualitative methods. EM clinicians, urologists, radiologists, researchers, and emergency department patients participated in focus groups and semi-structured interviews. All groups were recorded, transcribed, and analyzed in an ...


Role Of Serum Biomarkers In Early Detection Of Diabetic Cardiomyopathy In The West Virginian Population, Adam Shaver, Alexandra Nichols, Ellen A. Thompson, Amrita Mallick, Nandini Manne, Shanmuga Sundaram, Joseph I. Shapiro MD, Komal Sodhi 2019 Marshall University

Role Of Serum Biomarkers In Early Detection Of Diabetic Cardiomyopathy In The West Virginian Population, Adam Shaver, Alexandra Nichols, Ellen A. Thompson, Amrita Mallick, Nandini Manne, Shanmuga Sundaram, Joseph I. Shapiro Md, Komal Sodhi

Joseph I Shapiro MD

Objectives: Diabetic cardiomyopathy (DCM) is an established complication of diabetes mellitus. In West Virginia, the especially high incidence of diabetes and heart failure validate the necessity of developing new strategies for earlier detection of DCM. Since most DCM patients remain asymptomatic until the later stages of the disease when the fibrotic complications become irreversible, we aimed to explore biomarkers that can identify early-stage DCM.

Methods: The patients were grouped into 4 categories based on clinical diabetic and cardiac parameters: Control, Diabetes (DM), Diastolic dysfunction (DD), and Diabetes with diastolic dysfunction (DM+DD), the last group being the preclinical DCM group ...


Role Of Serum Biomarkers In Early Detection Of Diabetic Cardiomyopathy In The West Virginian Population, Adam Shaver, Alexandra Nichols, Ellen A. Thompson, Amrita Mallick, Nandini Manne, Shanmuga Sundaram, Joseph I. Shapiro MD, Komal Sodhi 2019 Marshall University

Role Of Serum Biomarkers In Early Detection Of Diabetic Cardiomyopathy In The West Virginian Population, Adam Shaver, Alexandra Nichols, Ellen A. Thompson, Amrita Mallick, Nandini Manne, Shanmuga Sundaram, Joseph I. Shapiro Md, Komal Sodhi

Komal Sodhi

Objectives: Diabetic cardiomyopathy (DCM) is an established complication of diabetes mellitus. In West Virginia, the especially high incidence of diabetes and heart failure validate the necessity of developing new strategies for earlier detection of DCM. Since most DCM patients remain asymptomatic until the later stages of the disease when the fibrotic complications become irreversible, we aimed to explore biomarkers that can identify early-stage DCM.

Methods: The patients were grouped into 4 categories based on clinical diabetic and cardiac parameters: Control, Diabetes (DM), Diastolic dysfunction (DD), and Diabetes with diastolic dysfunction (DM+DD), the last group being the preclinical DCM group ...


Low Back Pain, A Comprehensive Review: Pathophysiology, Diagnosis, And Treatment (Poster), Ivan Urits, Aaron Burshtein, Medha Sharma, Lauren Testa, Peter A. Gold, Vwaire Orhurhu, Omar Viswanath, Mark R. Jones, Moises A. Sidransky, Alan D. Kaye 2019 Harvard Medical School

Low Back Pain, A Comprehensive Review: Pathophysiology, Diagnosis, And Treatment (Poster), Ivan Urits, Aaron Burshtein, Medha Sharma, Lauren Testa, Peter A. Gold, Vwaire Orhurhu, Omar Viswanath, Mark R. Jones, Moises A. Sidransky, Alan D. Kaye

Senior Scholars Program

Purpose of Review: Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general U.S. adult population is 10-30%, and the lifetime prevalence of U.S. adults is as high as 65-80%.

Recent Findings: Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, and spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is ...


Role Of Mucosal Protrusion Angle In Discriminating Between True And False Masses Of The Small Bowel On Video Capsule Endoscopy, May Min, Michael Noujaim, Jonathan Green, Christopher R. Schlieve, Aditya Vaze, Mitchell A. Cahan, David R. Cave 2019 University of Massachusetts Medical School

Role Of Mucosal Protrusion Angle In Discriminating Between True And False Masses Of The Small Bowel On Video Capsule Endoscopy, May Min, Michael Noujaim, Jonathan Green, Christopher R. Schlieve, Aditya Vaze, Mitchell A. Cahan, David R. Cave

Senior Scholars Program

The diagnosis of small-bowel tumors is challenging due to their low incidence, nonspecific presentation, and limitations of traditional endoscopic techniques. In our study, we examined the utility of the mucosal protrusion angle in differentiating between true submucosal masses and bulges of the small bowel on video capsule endoscopy. We retrospectively reviewed video capsule endoscopies of 34 patients who had suspected small-bowel lesions between 2002 and 2017. Mucosal protrusion angles were defined as the angle between the small-bowel protruding lesion and surrounding mucosa and were measured using a protractor placed on a computer screen. We found that 25 patients were found ...


Engaging Emergency Department Patients In The Creation Of A Shared Decision-­Making Tool Regarding Ct Scanning In Kidney Stones: Challenges To Traditional Stakeholder Engagement, Elizabeth M. Schoenfeld, Connor J. Houghton, Pooja P. Patel, Leonora Merwin, Kathleen M. Mazor, Erik Hess, Charles Scales, Maggie Breslin, Peter K. Lindenauer 2019 University of Massachusetts Medical School

Engaging Emergency Department Patients In The Creation Of A Shared Decision-­Making Tool Regarding Ct Scanning In Kidney Stones: Challenges To Traditional Stakeholder Engagement, Elizabeth M. Schoenfeld, Connor J. Houghton, Pooja P. Patel, Leonora Merwin, Kathleen M. Mazor, Erik Hess, Charles Scales, Maggie Breslin, Peter K. Lindenauer

Community Engagement and Research Symposia

Background: Every year approximately 2 million patients are seen in US EDs for suspected renal colic, and the majority receive CT scans. The objective of our study was to develop a stakeholder-informed conversation aid to help clinicians use SDM regarding CT scanning in patients with suspected renal colic.

Methods: Using a published decision aid development framework, and under the direction of a multi-disciplinary Steering Committee, we engaged a diverse set of stakeholders via qualitative methods. EM clinicians, urologists, radiologists, researchers, and emergency department patients participated in focus groups and semi-structured interviews. All groups were recorded, transcribed, and analyzed in an ...


Detecting Hypoglycemia Incidents Reported In Patients' Secure Messages: Using Cost-Sensitive Learning And Oversampling To Reduce Data Imbalance, Jinying Chen, John Lalor, Weisong Liu, Emily Druhl, Edgard A. Granillo, Varsha G. Vimalananda, Hong Yu 2019 University of Massachusetts Medical School

Detecting Hypoglycemia Incidents Reported In Patients' Secure Messages: Using Cost-Sensitive Learning And Oversampling To Reduce Data Imbalance, Jinying Chen, John Lalor, Weisong Liu, Emily Druhl, Edgard A. Granillo, Varsha G. Vimalananda, Hong Yu

Open Access Articles

BACKGROUND: Improper dosing of medications such as insulin can cause hypoglycemic episodes, which may lead to severe morbidity or even death. Although secure messaging was designed for exchanging nonurgent messages, patients sometimes report hypoglycemia events through secure messaging. Detecting these patient-reported adverse events may help alert clinical teams and enable early corrective actions to improve patient safety.

OBJECTIVE: We aimed to develop a natural language processing system, called HypoDetect (Hypoglycemia Detector), to automatically identify hypoglycemia incidents reported in patients' secure messages.

METHODS: An expert in public health annotated 3000 secure message threads between patients with diabetes and US Department of ...


Nmd-12: A New Machine-Learning Derived Screening Instrument To Detect Mild Cognitive Impairment And Dementia, Pai-Yi Chiu, Haipeng Tang, Cheng-Yu Wei, Chaoyang Zhang, Guang-Uei Hung, Weihua Zhou 2019 Show Chwan Memorial Hospital

Nmd-12: A New Machine-Learning Derived Screening Instrument To Detect Mild Cognitive Impairment And Dementia, Pai-Yi Chiu, Haipeng Tang, Cheng-Yu Wei, Chaoyang Zhang, Guang-Uei Hung, Weihua Zhou

Faculty Publications

Introduction

Using machine learning techniques, we developed a brief questionnaire to aid neurologists and neuropsychologists in the screening of mild cognitive impairment (MCI) and dementia.

Methods

With the reduction of the survey size as a goal of this research, feature selection based on information gain was performed to rank the contribution of the 45 items corresponding to patient responses to the specified questions. The most important items were used to build the optimal screening model based on the accuracy, practicality, and interpretability. The diagnostic accuracy for discriminating normal cognition (NC), MCI, very mild dementia (VMD) and dementia was validated in ...


Design And Preliminary Findings From A New Electronic Cohort Embedded In The Framingham Heart Study, David D. McManus, Ludovic Trinquart, Emelia J. Benjamin, Emily S. Manders, Kelsey Fusco, Lindsey S. Jung, Nicole L. Spartano, Vik Kheterpal, Christopher Nowak, Mayank Sardana, Joanne M. Murabito 2019 University of Massachusetts Medical School

Design And Preliminary Findings From A New Electronic Cohort Embedded In The Framingham Heart Study, David D. Mcmanus, Ludovic Trinquart, Emelia J. Benjamin, Emily S. Manders, Kelsey Fusco, Lindsey S. Jung, Nicole L. Spartano, Vik Kheterpal, Christopher Nowak, Mayank Sardana, Joanne M. Murabito

Open Access Articles

BACKGROUND: New models of scalable population-based data collection that integrate digital and mobile health (mHealth) data are necessary.

OBJECTIVE: The aim of this study was to describe a cardiovascular digital and mHealth electronic cohort (e-cohort) embedded in a traditional longitudinal cohort study, the Framingham Heart Study (FHS).

METHODS: We invited eligible and consenting FHS Generation 3 and Omni participants to download the electronic Framingham Heart Study (eFHS) app onto their mobile phones and co-deployed a digital blood pressure (BP) cuff. Thereafter, participants were also offered a smartwatch (Apple Watch). Participants are invited to complete surveys through the eFHS app, to ...


An Observational Study With The Janssen Autism Knowledge Engine (Jake((R))) In Individuals With Autism Spectrum Disorder, Seth L. Ness, Jean A. Frazier 2019 Janssen Research & Development

An Observational Study With The Janssen Autism Knowledge Engine (Jake((R))) In Individuals With Autism Spectrum Disorder, Seth L. Ness, Jean A. Frazier

Open Access Articles

Objective: The Janssen Autism Knowledge Engine (JAKE(R)) is a clinical research outcomes assessment system developed to more sensitively measure treatment outcomes and identify subpopulations in autism spectrum disorder (ASD). Here we describe JAKE and present results from its digital phenotyping (My JAKE) and biosensor (JAKE Sense) components.

Methods: An observational, non-interventional, prospective study of JAKE in children and adults with ASD was conducted at nine sites in the United States. Feedback on JAKE usability was obtained from caregivers. JAKE Sense included electroencephalography, eye tracking, electrocardiography, electrodermal activity, facial affect analysis, and actigraphy. Caregivers of individuals with ASD reported behaviors ...


Diabetic Neuropathic Foot Without Neuropathy: Could It Be Cancer? - A Case Report, Jennifer Baima, Felix Santiago, Mathew J. Most 2019 University of Massachusetts Medical School

Diabetic Neuropathic Foot Without Neuropathy: Could It Be Cancer? - A Case Report, Jennifer Baima, Felix Santiago, Mathew J. Most

Orthopedics and Physical Rehabilitation Publications and Presentations

We present a case of a 64 year-old diabetic male who presented with months of progressively worsening foot pain and swelling, who was initially diagnosed with Charcot joint disease.(CJD) He was ultimately found to have a very rare tumor.


The Neutrophil-To-Lymphocyte And Monocyte-To-Lymphocyte Ratios Are Independently Associated With Neurological Disability And Brain Atrophy In Multiple Sclerosis, Christopher C. Hemond, Bonnie I. Glanz, Rohit Bakshi, Tanuja Chitnis, Brian C. Healy 2019 University of Massachusetts Medical School

The Neutrophil-To-Lymphocyte And Monocyte-To-Lymphocyte Ratios Are Independently Associated With Neurological Disability And Brain Atrophy In Multiple Sclerosis, Christopher C. Hemond, Bonnie I. Glanz, Rohit Bakshi, Tanuja Chitnis, Brian C. Healy

Open Access Articles

BACKGROUND: Serum hematological indices such as the neutrophil-lymphocyte ratio (NLR) or monocyte-lymphocyte ratio (MLR) have been used as biomarkers of pathogenic inflammation and prognostication in multiple areas of medicine; recent evidence shows correlation with psychological parameters as well.

OBJECTIVES/AIMS: To characterize clinical, neuroimaging, and psycho-neuro-immunological associations with NLR and MLR in persons with multiple sclerosis (MS).

METHODS: We identified a large cohort of clinically well-defined patients from our longitudinal database that included MS-related outcomes, disease-modifying therapy, patient-reported outcome (PRO) measures, and quantified cerebral MRI at 1.5 T. We queried hospital records for complete blood counts within 2 months ...


Rethinking Intravenous Catheter Size And Location For Computed Tomography Pulmonary Angiography, Travis Marshall, Nae Meng Chen, Eric Nguyen, David E. Slattery, Tony Zitek 2019 University of Nevada, Las Vegas

Rethinking Intravenous Catheter Size And Location For Computed Tomography Pulmonary Angiography, Travis Marshall, Nae Meng Chen, Eric Nguyen, David E. Slattery, Tony Zitek

School of Medicine Faculty Publications

Introduction: Computed tomography pulmonary angiography (CTPA) is the test of choice for diagnosis of pulmonary embolism (PE) in the emergency department (ED), but this test may be indeterminate for technical reasons such as inadequate contrast filling of the pulmonary arteries. Many hospitals have requirements for intravenous (IV) catheter size or location for CTPAs to reduce the chances of inadequate filling, but there is a lack of clinical data to support these requirements. The objective of this study was to determine if a certain size or location of IV catheter used for contrast for CTPA is associated with an increased chance ...


A “Diagnosis Method" For The Analysis Of Epidemiological Studies. A Reevaluation Of Pan, Et Al. Arch Intern Med 2012, 172:555., Richard D. Feinman, Eugene J. Fine 2019 SUNY Downstate Medical Center

A “Diagnosis Method" For The Analysis Of Epidemiological Studies. A Reevaluation Of Pan, Et Al. Arch Intern Med 2012, 172:555., Richard D. Feinman, Eugene J. Fine

Journal of Evolution and Health

The medical literature has been subject to extensive criticism for a lack of accuracy and reproducibility. A major cause, in our view, is misleading or inappropriate presentation and interpretation of statistical results. Emphasis on percentages or relative values (odds ratios, relative risk, and hazard ratio) always reduces and often obscures information. We suggest a more direct method using the 2 x 2 matrix commonly employed in diagnosis testing. We demonstrate the “diagnosis method,” by evaluating a previously published paper (Pan A, et al.: Arch Intern Med 2012, 172:555-563). on the risk of red meat for disease, focussing on cancer ...


Diffusion Tensor Imaging: In Vivo White Matter Structural And Connectivity Evaluation Of Glioma Pathophysiology For Future Clinical Application, Shawn D'souza 2019 University of Colorado, Boulder

Diffusion Tensor Imaging: In Vivo White Matter Structural And Connectivity Evaluation Of Glioma Pathophysiology For Future Clinical Application, Shawn D'Souza

Undergraduate Honors Theses

Gliomas account for 26.5% of all primary central nervous system tumors. Histopathological observation has been the gold standard for diagnosing and studying gliomas, however, this method has several limitations. Recent studies have used diffusion tensor imaging (DTI) to extract white matter fibers and the diffusion coefficients derived from the magnetic resonance processing to provide non-invasive insights into the extent of tumor invasion, axonal integrity, and pathophysiological differentiation of glioma from metastasis. This work extends the capabilities of DTI by examining whether a tract-based analysis can improve non-invasive localization of tumor impact on white matter integrity. This study also examines ...


From Witch Hunts To Autoantibodies: Overcoming Psychogenic Stigma To Uncover The Molecular Cause Of Autoimmunity, Emma Hainstock 2019 Regis University

From Witch Hunts To Autoantibodies: Overcoming Psychogenic Stigma To Uncover The Molecular Cause Of Autoimmunity, Emma Hainstock

All Regis University Theses

Due to the frequency of misdiagnosis of autoimmune diseases and their disproportionate incidence in women, my thesis explores historical misconceptions about autoimmune conditions which could have lingered in society to impede their diagnoses today. Antiphospholipid Antibody Syndrome (APS) and Anti-NMDA Receptor Encephalitis (ANRE) are the conditions I focused on, as both diseases can cause complex neurologic symptoms such as hallucinations and memory loss, which in combination with the fact that they are disproportionately suffered by women, have caused physicians in the past to misdiagnose patients as either hysteric or demonically possessed. I explore antiphospholipid antibody syndrome and anti-NMDA receptor encephalitis ...


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