Digital Commons Network^™

Outcomes Of Haploidentical Vs Matched Sibling Transplantation For Acute Myeloid Leukemia In First Complete Remission., Armin Rashidi, Mehdi Hamadani, Mei-Jie Zhang, Hai-Lin Wang, Hisham Abdel-Azim, Mahmoud Aljurf, Amer Assal, Ashish Bajel, Asad Bashey, Minoo Battiwalla, Amer M. Beitinjaneh, Nelli Bejanyan, Vijaya Raj Bhatt, Javier Bolaños-Meade, Michael Byrne, Jean-Yves Cahn, Mitchell Cairo, Stefan Ciurea, Edward Copelan, Corey Cutler, Andrew Daly, Miguel-Angel Diaz, Nosha Farhadfar, Robert P. Gale, Siddhartha Ganguly, Michael R. Grunwald, Theresa Hahn, Shahrukh Hashmi, Gerhard C. Hildebrandt, H. Kent Holland, Nasheed Hossain, Christopher G Kanakry, Mohamed A. Kharfan-Dabaja, Nandita Khera, Yener Koc, Hillard M. Lazarus, Jong-Wook Lee, Johan Maertens, Rodrigo Martino, Joseph Mcguirk, Reinhold Munker, Hemant S. Murthy, Ryotaro Nakamura, Sunita Nathan, Taiga Nishihori, Neil D. Palmisiano, Sagar Patel, Joseph Pidala, Rebecca Olin, Richard F. Olsson, Betul Oran, Olov Ringden, David Rizzieri, Jacob Rowe, Mary Lynn Savoie, Kirk R. Schultz, Sachiko Seo, Brian C. Shaffer, Anurag Singh, Melhem Solh, Keith Stockerl-Goldstein, Leo F. Verdonck, John Wagner, Edmund K. Waller, Marcos De Lima, Brenda M. Sandmaier, Mark Litzow, Dan Weisdorf, Rizwan Romee, Wael Saber

Department of Medical Oncology Faculty Papers

HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy–based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor–based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs …

Topological Dna Damage, Telomere Attrition And T Cell Senescence During Chronic Viral Infections, Yingjie Ji, Xindi Dang, Lam Ngoc Thao Nguyen, Lam Nhat Nguyen, Jaun Zhao, Dechao Cao, Sushant Khanal, Madison Schank, Xiao Y. Wu, Zheng D. Morrison, Yue Zou, Mohamed El Gazzar, Shunbin Ning, Ling Wang, Jonathan P. Moorman, Zhi Q. Yao

ETSU Faculty Works

Background: T cells play a key role in controlling viral infections; however, the underlying mechanisms regulating their functions during human viral infections remain incompletely understood. Here, we used CD4 T cells derived from individuals with chronic viral infections or healthy T cells treated with camptothecin (CPT) - a topoisomerase I (Top 1) inhibitor - as a model to investigate the role of DNA topology in reprogramming telomeric DNA damage responses (DDR) and remodeling T cell functions.

Results: We demonstrated that Top 1 protein expression and enzyme activity were significantly inhibited, while the Top 1 cleavage complex (TOP1cc) was …

Advancing Measurement And Monitoring Of Reproductive, Maternal, Newborn And Child Health And Nutrition: Global And Country Perspectives, Tanya Marchant, Zulfiqar Ahmed Bhutta, Robert Black, John Grove, Catherine Kyobutungi, Stefan Peterson

Department of Paediatrics and Child Health

No abstract provided.

Table Of Contents: The Medicine Forum Volume 20, 2018-2019

The Medicine Forum

Clinical Images

Case Reports

• Cardiology
• Endocrinology
• Gastroenterology and Hepatology
• Hematology and Oncology
• Infectious Disease
• Pulmonary Medicine
• Rheumatology

Original Article

Editorial

Literature Review

Creative Writing

The Medicine Forum: Volume 20

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 20, 2018-2019

TABLE OF CONTENTS

Clinical Images

Case Reports

• Cardiology
• Endocrinology
• Gastroenterology and Hepatology
• Hematology and Oncology
• Infectious Disease
• Pulmonary Medicine
• Rheumatology

Original Article

Editorial

Literature Review

Creative Writing

Making Sure Your Voice Is Heard Lgbtqi Documentation For End Of Life, Kenneth J. Mangano Bhas, Mcm

Patient Care Services / Nursing

No abstract provided.

Antimicrobial Susceptibility Against Metronidazole And Carbapenem In Clinical Anaerobic Isolates From Pakistan, Kauser Jabeen, Yusra Shafquat, Joveria Farooqi, Kiran Mehmood, Seema Irfan, Rumina Hasan, Afia Zafar

Department of Pathology and Laboratory Medicine

Background: Globally metronidazole and carbapenem resistance in anaerobic organisms is increasing necessitating continuous surveillance to guide selection of empirical treatment. In this study we have determined metronidazole resistance in anaerobes using MIC Evaluator strips (M.I.C.E strips). Carbapenem resistance was evaluated only in metronidazole resistant isolates.
Material and methods: The study was conducted at the Aga Khan University (AKU) Hospital laboratory, Karachi, Pakistan (2014–2017). Metronidazole and imipenem resistance was evaluated using M.I.C.E strips and minimum inhibitory concentrations (MICs) were interpreted using Clinical Laboratory Standards Institute (CLSI) criteria. Clinical details including demographics, prolonged hospital stay, malignancy, transplant, dialysis, diabetes, site of infection …

Collaborative Molecular Epidemiology Study Of Metabolic Dysregulation, Dna Methylation, And Breast Cancer Risk Among Nigerian Women: Mend Study Objectives And Design, Tomi Akinyemiju, Omolola Salako, Adetola Daramola, Olusegun Alatise, Adewale Adeniyi, Gabriel Ogun, Omobolaji Ayandipo, Thomas Olajide, Olalekan Olasehinde, Olukayode Arowolo, Adewale Adisa, Oludolapo Afuwape, Aralola Olusanya, Aderemi Adegoke, Akinlolu Ojo, Trygve Tollefsbol, Donna K. Arnett

Epidemiology and Environmental Health Faculty Publications

PURPOSE To elucidate the role of metabolic dysregulation and associated DNA methylation changes on breast cancer risk and aggressive subtypes among Nigerian women. We describe the design and methods of a collaborative molecular epidemiology study of breast cancer in Nigerian hospitals.

METHODS The Mechanisms for Novel and Established Risk Factors for Breast Cancer in Women of Nigerian Descent (MEND) study was designed as a matched case-control study of 350 patients, age 18 to 75 years, with newly diagnosed, treatment-naïve breast cancer and 350 age-matched healthy controls from surrounding geographic areas. Patients with breast cancer seen for initial diagnosis at four …

How Health Care Providers Can Use Digital Health Technologies To Inform Human Papillomavirus (Hpv) Decision Making And Promote The Hpv Vaccine Uptake Among Adolescents And Young Adults, Versie Johnson-Mallard, Gabrielle Darville, Rebeccah Mercado, Charkarra Anderson-Lewis, Jann Macinnes

Faculty Publications

High-risk stains of human papillomavirus (HPV) is linked to causing cancer, is highly prevalent, and has increased incidence among adolescents and young adults. However, vaccination rates are low. Health care provider recommendation is the biggest influencer toward vaccine uptake. Since more health care providers are using digital health technologies in their medical practices, this study investigated the feasibility of technology to increase informed decision making. A convenience sample of 210 students completed an online survey. Participants were 18–25 years of age (88%), female (85%), Caucasian (60%), and never been diagnosed with HPV (92.9%). Overwhelmingly, participants owned a smartphone (98.9%) and …

Aspiration Pneumonia After Spine Surgery At Tjuh, Daniel Franco, Md, Jesse Edwards, Md, Kristen Vogl, Pt, Barbara Baskin, Slp, James Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Problem Definition

Aspiration Pneumonia after Spine Surgery at TJUH has a disproportionately high incidence, compared to other major academic centers When Aspiration Pneumonia is diagnosed in the immediate post operative period, this cascades into increased length of stay, increased overall cost and possibility negative impact for physician and hospital reimbursement At this time, it is unclear which criteria are used by physicians to determine whether an aspiration event has happened.

Reduction Of The Duration Of Contact Precautions In Patients With A Positive Mrsa Swab, Fadi Al-Saiegh, Md, Phyllis Flomenberg, Md, Giuliana Labella, Rn, Kelli Mcrory, James Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Contact precautions (CP) in hospitals are a method of infection control in the transmission of multi-drug resistant organisms. Unfortunately, even though colonization with nasal methicillin-resistant Staphylococcus aureus (MRSA) is common in asymptomatic patients (3.8-4.5%) (6,7), patients are screened for nasal MRSA since it associated with higher morbidity and mortality. However, those who test positive for nasal MRSA are kept on CP even with a cleared MRSA infection(1). At TJUH, patients were kept on CP for 24 months after a positive swab regardless of location. This, unfortunately, led to unintended negative consequences: delay in patient transfer to other facilities (e. …

Price Variance For Malaria Prophylaxis Among Northeastern Us Pharmacies, Marcelo Gareca Md, Mark Knouse Md

Department of Medicine

No abstract provided.

An Infection Control Journey In Hospital Based Practice Conversion, Cathleen Strzalka, Mph, Cph, Cic, Kelly Zabriskie, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

• Effectively bring physician based practices (PBPs) under hospital licensure
• Ensure safe delivery of care
• Produce successful regulatory surveys

Physician Based Practices And Instrument Sterilization - How Do You Do It?, Kelly Zabriskie, Cic, Cathleen Strzalka, Mph, Cph, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

To develop a process that allows the PBP to operate efficiently and effectively but still be compliant with proper instrument reprocessing rules and regulations.

Hand Hygiene Observations… Not So Secret Anymore, Mary Ehly, Bsn, Rn, Cic, Courtney Mitchell, Mph, Cic, Charlotte Sacksteder, Ba, Kelly Zabriskie, Bs, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

To create a hand hygiene surveillance program to reduce bias, be more reliable, yield a greater number of observations, and provide real time feedback

Promoting Adherence To Influenza Vaccination Recommendations In Pediatric Practice., Lloyd N. Werk, Maria Carmen Diaz, Adriana Cadilla, James P. Franciosi, Jobayer Hossain

Jefferson Health - Northeast Papers (formerly Aria Health Papers)

OBJECTIVES: In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence.

METHODS: We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children's health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], …

Analysis Of Candida Auris Fungemia At A Single Facility In Kenya, Rodney Adam, Gunturu Revathi, Nancy Okinda, Melanie Fontaine, Jasmit Shah, Elizabeth Kagotho, Mariana Castanheira, Michael A. Pfaller, Daniel Maina

Pathology, East Africa

Objectives: Candida auris emerged as a human pathogen in 2009 and has subsequently been identified around the world as a cause of invasive candidiasis. We did an analysis from a single institution in order to analyze risk factors and outcomes for C. auris candidemia.

Methods: Patients with candidemia were identified by the electronic medical record and reviewed for risk factors and outcome. Candida isolates were identified by Vitek2 as Candida haemulonii, but species determinations for 21 of the isolates using published molecular and proteomic methods identified all as C. auris.

Findings: From September 2010 to December 2016, C. auris accounted …

Drug-Induced Acute-On-Chronic Liver Failure In Asian Patients, Harshad Devarbhavi, Saeed Hamid

Section of Gastroenterology

Objectives: Acute insults from viruses, infections, or alcohol are established causes of decompensation leading to acute-on-chronic liver failure (ACLF). Information regarding drugs as triggers of ACLF is lacking. We examined data regarding drugs producing ACLF and analyzed clinical features, laboratory characteristics, outcome, and predictors of mortality in patients with drug-induced ACLF.

Metods: We identified drugs as precipitants of ACLF among prospective cohort of patients with ACLF from the Asian Pacific Association of Study of Liver (APASL) ACLF Research Consortium (AARC) database. Drugs were considered precipitants after exclusion of known causes together with a temporal association between exposure and decompensation. Outcome …

Exploring The Relationship Between Medical Insurance And Vaccine Acceptance Rates, Mark Knouse Md, Yennifer Lopez, Hope Kincaid Mph, Cph, Shae Duka Bs

Department of Medicine

No abstract provided.

Experience Of An Infectious Diseases (Id) Travel Medicine Clinic During A National Shortage Of Yellow Fever Vaccine (Yfv), Mark Knouse Md, Terri I. Langham Rn, Marcelo Gareca Md, Jarrod W. Kile Rphd

Department of Medicine

No abstract provided.

Is It Really Transverse Myelitis? Acute Flaccid Myelitis A Rare Entity., Hina Yusuf, Arsalan Ahmad, Ejaz Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

Acute Flaccid Myelitis is a relatively new and rare disease entity which was recognized for the first time in United States in 20121. Usually children below 18 years of age present with sudden onset rapidly progressive flaccid paralysis sometimes following upper respiratory tract infection. To date no cases have been reported from Afghanistan and Pakistan. We are reporting case of a young girl who presented with sudden onset flaccid paralysis and respiratory distress. Her MRI Cervical spine showed longitudinally extensive transverse myelitis. One year after the onset of disease flaccid paraparesis continued despite various treatments. It is important to report …

Commencement, Philadelphia (2019), Philadelphia College Of Osteopathic Medicine

Commencements

Philadelphia Campus Graduate Program Commencement program, Class of 2019. Degrees include Doctor of Osteopathic Medicine.

Disruption Of Telomere Integrity And Dna Repair Machineries By Kml001 Induces T Cell Senescence, Apoptosis, And Cellular Dysfunctions, Dechao Cao, Juan Zhao, Lan N. Nguyen, Lam N. T. Nguyen, Sushant Khanal, Xindi Dang, Madison Schank, Bal K. Chand Thakuri, Xiao Y. Wu, Zheng D. Morrison, Mohamed El Gazzar, Yue Zou, Shunbin Ning, Ling Wang, Jonathan P. Moorman, Zhi Q. Yao

ETSU Faculty Works

T cells in chronic viral infections are featured by premature aging with accelerated telomere erosion, but the mechanisms underlying telomere attrition remain unclear. Here, we employed human CD4 T cells treated with KML001 (a telomere-targeting drug) as a model to investigate the role of telomere integrity in remodeling T cell senescence. We demonstrated that KML001 could inhibit cell proliferation, cytokine production, and promote apoptosis via disrupting telomere integrity and DNA repair machineries. Specifically, KML001-treated T cells increased dysfunctional telomere-induced foci (TIF), DNA damage marker γH2AX, and topoisomerase cleavage complex (TOPcc) accumulation, leading to telomere attrition. Mechanistically, KML001 compromised telomere integrity …

Provider Education And Rapid Antigen Detection Test Use In An Academic Pediatric Clinic, Steven Dahl

Research Days

No abstract provided.

Impact Of A Mobile Device-Based Clinical Decision Support Tool On Guideline Adherence And Mental Workload Among Trainee And Attending Physicians, Katherine M. Richardson

Presentations

This study evaluated PedsGuide, an app used to evaluate serious bacterial infections in febrile infants.

The Disproportionate Impact Of Obesity Among Hospitalized Children, Kathyrn Kyler

Research Days

No abstract provided.

Herpes Simplex Virus Whole Genome Sequencing For Antiviral Resistance In A Child With Dock8 Deficiency And Chronic Infection, Sean Stout

Research Days

No abstract provided.

Chronic Cavitary Pulmonary Aspergillosis With Aspergilloma In A Previously Healthy Teenager, Michael D. Mcdowell Jr

Research Days

No abstract provided.

Incorporating Oral Health Care In Pediatric Primary Care Practice, Salamatu Yusif

Evidence-Based Practice Project Reports

The most common chronic disease in childhood is dental caries and is more prevalent than asthma and hay fever (HHS, 2000). Data show that in the United States from 2011-2014, 24% of children aged 2-5 years had experienced dental caries in their primary teeth, with 11% having untreated caries (Dye et al., 2017). Primary care clinicians have an important role to play in promoting children’s oral health as much as dentists because they have more contact with children. The purpose of this evidence-based practice project was to integrate an evidence-based oral health program for children in a pediatric primary care …

Grfs And Crfs In Alternative Donor Hematopoietic Cell Transplantation For Pediatric Patients With Acute Leukemia., Rohtesh S. Mehta, Shernan G Holtan, Tao Wang, Michael T. Hemmer, Stephen R. Spellman, Mukta Arora, Daniel R. Couriel, Amin M. Alousi, Joseph Pidala, Hisham Abdel-Azim, Ibrahim Ahmed, Mahmoud Aljurf, Medhat Askar, Jeffery J. Auletta, Vijaya Bhatt, Christopher Bredeson, Saurabh Chhabra, Shahinaz Gadalla, James Gajewski, Robert Peter Gale, Usama Gergis, Peiman Hematti, Gerhard C. Hildebrandt, Yoshihiro Inamoto, Carrie Kitko, Pooja Khandelwal, Margaret L. Macmillan, Navneet Majhail, David I. Marks, Parinda Mehta, Taiga Nishihori, Richard F. Olsson, Attaphol Pawarode, Miguel Angel Diaz, Tim Prestidge, Muna Qayed, Hemalatha Rangarajan, Olle Ringden, Ayman Saad, Bipin N. Savani, Sachiko Seo, Ami Shah, Niketa Shah, Kirk R. Schultz, Melhem Solh, Thomas Spitzer, Jeffrey Szer, Takanori Teshima, Leo F Verdonck, Kirsten M. Williams, Baldeep Wirk, John Wagner, Jean A. Yared, Daniel J. Weisdorf

Department of Medical Oncology Faculty Papers

We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P < .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P < .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors. © 2019 American Society of Hematology. All rights reserved.