Digital Commons Network^™

A Multi-Institutional Analysis Of Sternoclavicular Joint Coverage Following Osteomyelitis, Sammy Othman, Omar Elfanagely, Saïd C Azoury, Geoffrey M Kozak, Jessica Cunning, Arturo J Rios-Diaz, Prashanth Palvannan, Patrick J. Greaney, Matthew Jenkins, Doraid Jarrar, Stephen J Kovach, John P Fischer

Department of Surgery Faculty Papers

BACKGROUND: Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction.

METHODS: A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed.

RESULTS: Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were …

How I Treat Acute And Persistent Sickle Cell Pain., Samir K. Ballas

Cardeza Foundation for Hematologic Research

Sickle pain is the hallmark of sickle cell disease (SCD). It could be acute, persistent/relapsing, chronic, or neuropathic. Although there is a general consensus that pain is a major manifestation of SCD, there is a controversy as to the types of pain and their interrelationship between acute, chronic, relapsing, persistent, etc. This report first reviews the general approach to the management of acute vaso-occlusive crisis (VOC) pain, including education, counseling, pharmacotherapy, non-pharmacotherapy, and fluid therapy. This is followed by the presentation of five patients that represent typical issues that are commonly encountered in the management of patients with SCD. These …

Letter: Thrombotic Neurovascular Disease In Covid-19 Patients., Ahmad Sweid, Batoul Hammoud, Joshua H. Weinberg, Mazen Oneissi, Eytan Raz, Maksim Shapiro, Maureen Deprince, Stavropoula Tjoumakaris, Michael R. Gooch, Nabeel A. Herial, Hekmat Zarzour, Victor Romo, Robert Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Faculty Papers

Although the respiratory system is the primary target of the coronavirus, studies have demonstrated a strong tropism to the central nervous system (CNS).^1,2 The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. This receptor is also found in the CNS and plays a crucial role in autoregulating cerebral perfusion pressure.^3,4 Additionally, epidemiological data demonstrated increased mortality due to cardiovascular and cerebrovascular diseases during flu pandemics due to a hypercoagulable state.^5,6 The triad of neuroinvasion of SARS-CoV-2, induction of hypercoagulable state,^{5-9 …}

In Reply: May Cooler Heads Prevail During A Pandemic: Stroke In Covid-19 Patients Or Covid-19 In Stroke Patients?, Pascal Jabbour, Ahmad Sweid, Stavropoula Tjoumakaris, Michel Piotin, Waleed Brinjikji, Kimon Bekelis, Eytan Raz, Nader Sourour, Shahid M. Nimjee, Demetrius K. Lopes, Ameer E. Hassan, Aditya S. Pandey, L. Fernando Gonzalez, Ricardo A. Hanel, Adnan H. Siddiqui, David Hasan, Sean D. Lavine, Bernard R. Bendok

Department of Neurosurgery Faculty Papers

No abstract provided.

Core Topic: Anemia, Marisyl De La Cruz, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Agenda

• Diagnosis and evaluation
• Approach to anemia
• Hypoproliferative
• Hyperproliferative
• Management of common anemias
• Cases
• Q & A

• Become familiar with signs and symptoms of anemia
• Use laboratory findings to differentiate anemias
• Review pathophysiology of anemia and recognize anemia as a symptom of other conditions
• Understand management of common anemias seen in primary care

When Limb Surgery Has Become The Only Life-Saving Therapy In Fop: A Case Report And Systematic Review Of The Literature, Esmée Botman, Sanne Treurniet, Wouter D Lubbers, Lothar A Schwarte, Patrick R Schober, Louise Sabelis, Edgar J G Peters, Annelies Van Schie, Ralph De Vries, Zvi Grunwald, Bernard J Smilde, Jakko A Nieuwenhuijzen, Marieke Visser, Dimitra Micha, Nathalie Bravenboer, J Coen Netelenbos, Bernd P Teunissen, Pim De Graaf, Pieter G H M Raijmakers, Jan Maerten Smit, Elisabeth M W Eekhoff

Department of Anesthesiology Faculty Papers

Fibrodysplasia ossificans progressiva (FOP) is a rare disease in which heterotopic ossification (HO) is formed in muscles, tendons and ligaments. Traumatic events, including surgery, are discouraged as this is known to trigger a flare-up with risk of subsequent HO. Anesthetic management for patients with FOP is challenging. Cervical spine fusion, ankylosis of the temporomandibular joints, thoracic insufficiency syndrome, restrictive chest wall disease, and sensitivity to oral trauma complicate airway management and anesthesia and pose life-threatening risks. We report a patient with FOP suffering from life-threatening antibiotic resistant bacterial infected ulcers of the right lower leg and foot. The anesthetic, surgical …

Covid-19 And Possible Links With Parkinson's Disease And Parkinsonism: From Bench To Bedside, David Sulzer, Angelo Antonini, Valentina Leta, Anna Nordvig, Richard Jay Smeyne, James E Goldman, Osama Al-Dalahmah, Luigi Zecca, Alessandro Sette, Luigi Bubacco, Olimpia Meucci, Elena Moro, Ashley S Harms, Yaqian Xu, Stanley Fahn, K Ray Chaudhuri

Department of Neuroscience Faculty Papers

This Viewpoint discusses insights from basic science and clinical perspectives on coronavirus disease 2019 (COVID-19)/severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection in the brain, with a particular focus on Parkinson's disease. Major points include that neuropathology studies have not answered the central issue of whether the virus enters central nervous system neurons, astrocytes or microglia, and the brain vascular cell types that express virus have not yet been identified. Currently, there is no clear evidence for human neuronal or astrocyte expression of angiotensin-converting enzyme 2 (ACE2), the major receptor for viral entry, but ACE2 expression may be activated by inflammation, and …

Hamman-Rich Syndrome: A Diagnosis Of Exclusion In The Covid-19 Pandemic., Qian Zhang, Ahmad Raza, Vincent Chan, Artem Minalyan, John Madara, Md

Abington Jefferson Health Papers

Hamman-Rich syndrome is a rapidly progressive interstitial lung disease with acute respiratory distress syndrome physiology. It carries a grave prognosis and a high early mortality rate. It is often distinguished from other similar pulmonary pathologies based on the clinical course, laboratory findings, bronchoalveolar lavage testing, and pathology report. We detail a 77-year-old lady with no prior pulmonary disease, smoking history, or occupational and environmental exposures present to the emergency department found to be in acute hypoxic respiratory failure with impressive progressive radiographic findings. The presumptive diagnosis of Hamman-Rich syndrome was made based on a combination of factors after ruling out …

A Case Report Of Bullous Subconjunctival Hemorrhag In Adenoviral Conjunctivitis, Sean Haynie, Jesse Johnson, Md

The Medicine Forum

A 78-year-old female with a past medical history of optic neuropathy and atrial fibrillation on warfarin presented with two weeks of progressive bilateral eye redness, swelling, pain, and blurry vision.

Table Of Contents: The Medicine Forum Volume 21, 2019-2020

The Medicine Forum

Table of Contents: The Medicine Forum Volume 21, 2019-2020

Fatal Case Of Newborn Lassa Fever Virus Infection Mimicking Late Onset Neonatal Sepsis: A Case Report From Northern Nigeria, Taofik Oluwaseun Ogunkunle, Surajudeen Oyeleke Bello, Chinwe Immaculata Anderson, Rashida Musa, Rasaq Olaosebikan, Abdulazeez Imam

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Lassa fever is a zoonotic viral infection endemic to the West Africa countries. It is highly fatal during pregnancy and as such reports of neonatal onset Lassa fever infections are rare in scientific literature. We report a fatal case of Lassa fever in a 26-day-old neonate mimicking the diagnosis of late-onset neonatal sepsis.

CASE PRESENTATION: The patient is a 26-day-old neonate who was admitted with a day history of fever, poor feeding, pre-auricular lymphadenopathy and sudden parental death. He was initially evaluated for late onset neonatal sepsis. He later developed abnormal bleeding and multiple convulsions while on admission, prompting …

Chimeric Ad5.F35 Vector Evades Anti-Adenovirus Serotype 5 Neutralization Opposing Gucy2c-Targeted Antitumor Immunity, John C. Flickinger, Jagmohan Singh, Robert D Carlson, Elinor Leong, Trevor R. Baybutt, Joshua Barton, Ellen M. Caparosa, Amanda M. Pattison, Jeff A. Rappaport, Jamin Roh, Tingting Zhan, Babar Bashir, Scott A Waldman, Adam E. Snook

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Adenovirus serotype 5 (Ad5) is a commonly used viral vector for transient delivery of transgenes, primarily for vaccination against pathogen and tumor antigens. However, endemic infections with Ad5 produce virus-specific neutralizing antibodies (NAbs) that limit transgene delivery and constrain target-directed immunity following exposure to Ad5-based vaccines. Indeed, clinical trials have revealed the limitations that virus-specific NAbs impose on the efficacy of Ad5-based vaccines. In that context, the emerging focus on immunological approaches targeting cancer self-antigens or neoepitopes underscores the unmet therapeutic need for more efficacious vaccine vectors.

METHODS: Here, we evaluated the ability of a chimeric adenoviral vector (Ad5.F35) …

The Medicine Forum: Volume 21

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 21, 2019-2020

TABLE OF CONTENTS

Clinical Images

Case Reports

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

Literature Review

Editorial

Lyssavirus Vaccine With A Chimeric Glycoprotein Protects Across Phylogroups, Christine R Fisher, David E Lowe, Todd G Smith, Yong Yang, Christina L Hutson, Christoph Wirblich, Gino Cingolani, Matthias J. Schnell

Department of Biochemistry and Molecular Biology Faculty Papers

Rabies is nearly 100% lethal in the absence of treatment, killing an estimated 59,000 people annually. Vaccines and biologics are highly efficacious when administered properly. Sixteen rabies-related viruses (lyssaviruses) are similarly lethal, but some are divergent enough to evade protection from current vaccines and biologics, which are based only on the classical rabies virus (RABV). Here we present the development and characterization of LyssaVax, a vaccine featuring a structurally designed, functional chimeric glycoprotein (G) containing immunologically important domains from both RABV G and the highly divergent Mokola virus (MOKV) G. LyssaVax elicits high titers of antibodies specific to both RABV …

Refugee Health In Philadelphia, Marc Altshuler

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

1. Define the U.S. refugee resettlement process
2. Discuss the history of refugee health in Philadelphia and the creation of the Jefferson Center for Refugee Health
3. Review selected data on our patients
4. Learn how to utilize new resources to care for refugees

Resident Ume Updates, Fred Markham, Marisyl Delacruz

Department of Family & Community Medicine Presentations and Grand Rounds

Agenda

1. Guidelines for Students in Clinical Spaces
2. Grading and feedback
3. RIME scheme
4. Telehealth, QI curriculum
5. Phase 3 Updates and JeffDOT
6. Q&A

Adapting A Teaching Hospital To A Covid Environment

Jefferson Surgical Solutions

The last ten days have been unlike any other we have known. People throughout the world are acting to slow the spread of a dangerous virus that threatens to strain the capacity of our hospitals and our caregivers; and its effects have already deeply impacted normal day to day life. I ask for your support and forbearance during this difficult time.

Charles J. Yeo, MD, FACS, Enterprise Chair of Surgery, shared those words in a letter to the Department of Surgery on March 19, 2020. In the days and weeks following, the Department came together to meet the unprecedented challenges …

Meta-Analysis Of Outcomes Of Patients With Covid-19 Infection With Versus Without Gastrointestinal Symptoms., Fahad Gul, Kevin Bryan Lo, Julie Peterson, Peter A Mccullough, Abhinav Goyal, Janani Rangaswami

COVID-19 Papers, Posters, and Presentations

This systematic review analyzed whether the presence or absence of gastrointestinal symptoms in patients with SARS-COV-2 infection is associated with adverse outcomes. Searching the Cochrane Center Register of Controlled Trials, we included any studies looking at patients with COVID-19 with gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) compared to those with COVID-19 but without gastrointestinal manifestations as a control group. The final search yielded 186 articles, all of which were individually screened. Seven studies were identified but three were excluded: one due to lack of a control group without gastrointestinal symptoms, one reported as viral RNA in the stool, and …

Defective Early Innate Immune Response To Ectromelia Virus In The Draining Lymph Nodes Of Aged Mice Due To Impaired Dendritic Cell Accumulation., Colby Stotesbury, Eric B Wong, Lingjuan Tang, Brian Montoya, Cory J Knudson, Carolina R Melo-Silva, Luis J Sigal

Department of Microbiology and Immunology Faculty Papers

It is known that aging decreases natural resistance to viral diseases due to dysfunctional innate and adaptive immune responses, but the nature of these dysfunctions, particularly in regard to innate immunity, is not well understood. We have previously shown that C57BL/6J (B6) mice lose their natural resistance to footpad infection with ectromelia virus (ECTV) due to impaired maturation and recruitment of natural killer (NK) cells to the draining popliteal lymph node (dLN). More recently, we have also shown that in young B6 mice infected with ECTV, the recruitment of NK cells is dependent on a complex cascade whereby migratory dendritic …

Calculating Life And Death In A Time Of Covid, Larry Hirschhorn, Phd

School of Continuing and Professional Studies Coronavirus Papers

The current pandemic makes us feel helpless. We can respond to its predation pragmatically but its silent march through the population promotes dread. Our helplessness undermines our belief in our culture as the source of our self-esteem and felt significance. One response to our experience of helplessness is the omnipotent stance, the idea that we can master the virus, stop it in its tracks, command one another to comply with injunctions and wreak a path of destruction by devastating the economy. Omnipotence promotes magical thinking. In the service of defeating death, we ignore actual suffering; deaths of despair and deaths …

Farber Hospitalist Service – Last 5 Years Of A Service Dedicated To The Medical Management Of Neurosurgical Patients, Rene Daniel, Catriona Mcdonald Harrop

JHN Journal

Neurosurgery hospitalists are closely involved in management of patients that undergo neurosurgery. In this article, we outline and discuss the major aspects of the work of these physicians. We emphasize the crucial role of these physicians in both preoperative and postoperative care as well as their roles in education and research. We also highlight the work of the Farber Hospitalist Service (FHS) for the last 5 year period, and point out the differences between FHS and other neurosurgery hospitalist services nationwide. It is hoped that this article will shed light on the work of neurosurgery hospitalists and help to clarify …

Management Of Hyperglycemia In The Neurosurgery Patient, Rene Daniel, Satya Villuri, Kevin Furlong

JHN Journal

Hyperglycemia is associated with adverse outcomes in patients who are candidates for or underwent neurosurgical procedures. Specific concerns and settings that relate to these patients are preoperative glycemic control, intraoperative control, management in the neurological intensive care unit (NICU), and postoperative control. In each of these settings, physicians have to ensure appropriate glycemic control to prevent or minimize adverse events. The glycemic control is usually managed by a neurohospitalist in co-management with the neurosurgery team pre- and postoperatively, and by the neurocritical care team in the setting of NICU. In this review article, we outline current standards of care for …

Opportunities And Challenges –The Next 5 Years Of A Service Dedicated To The Medical Management Of Neurosurgical Patients, Rene Daniel, Catriona Mcdonald Harrop

JHN Journal

Neurosurgery hospitalists will continue to be closely involved in the management of patients which undergo neurosurgery. In the first article, we discuss the tremendous potential of the service for improving the care for neurosurgical patients at Jefferson. We highlight the interactions with other services and the areas for potential growth. Further, we emphasize the need for constant feedback, which is necessary to improve the care provided by FHS.

In the second part of the article, we highlight the potential impact of FHS beyond the Jefferson Hospitals in Center City of Philadelphia, to other hospitals within the Jefferson network, and beyond …

The Membrane Protein Ankh Is Crucial For Bone Mechanical Performance By Mediating Cellular Export Of Citrate And Atp, Flóra Szeri, Stefan Lundkvist, Sylvia Donnelly, Udo F H Engelke, Kyu Rhee, Charlene J Williams, John P Sundberg, Ron A Wevers, Ryan Tomlinson, Robert S Jansen, Koen Van De Wetering

Department of Dermatology and Cutaneous Biology Faculty Papers

The membrane protein ANKH was known to prevent pathological mineralization of joints and was thought to export pyrophosphate (PPi) from cells. This did not explain, however, the presence of ANKH in tissues, such as brain, blood vessels and muscle. We now report that in cultured cells ANKH exports ATP, rather than PPi, and, unexpectedly, also citrate as a prominent metabolite. The extracellular ATP is rapidly converted into PPi, explaining the role of ANKH in preventing ankylosis. Mice lacking functional Ank (Ankank/ank mice) had plasma citrate concentrations that were 65% lower than those detected in wild type control animals. Consequently, citrate …

The Bulletin: Sidney Kimmel Medical College At Thomas Jefferson University, Volume 69, Issue 2, Summer 2020

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

This issue includes:

• A Message from the President Facing Crises with Creativity
• Dean’s Column Difficult Times Define Us
• Jefferson COVID Stories
• Reflections from the Frontlines
• One Step of Many White Coats for Black Lives Peaceful Protest at Jefferson
• Time Capsule Philadelphia 1918: The Flu Pandemic Hits Home
• A Message from Elizabeth A. Dale Helping the Heroes
• Discovery Combating COVID-19
• Heroes on the Sidelines Sidelined from Patient Care, SKMC Students Find Purpose in Volunteer Work
• From the Front Lines to Online SKMC Doesn’t Miss a Beat in Medical Education
• Navigating Uncharted Waters in Search of the Class of 2024
• You’ve Got …

Improving Nutrition And Immunity With Dry Chain And Integrated Pest Management Food Technologies In Lmics., Peetambar Dahal, Meghnath Dhimal, Krishna Belbase, Sundar Tiwari, John Groopman, Keith West, Bradley Pollock, Subodh Pyakurel, Ganga Acharya, Sunil Aryal, Yug Nath Ghimire, Manish Neupane, Rosina Poudel, Johan Van Ashbrouck, Keshavulu Kunusoth, Sarah De Saeger, Marthe De Boevre, Gokarna Gharti-Chhetri, Tek Bahadur Gurung, Kent J Bradford

Department of Medical Oncology Faculty Papers

No abstract provided.

C1q/Tnf-Related Protein 5 Contributes To Diabetic Vascular Endothelium Dysfunction Through Promoting Nox-1 Signaling., Jing Liu, Zhijun Meng, Lu Gan, Rui Guo, Jia Gao, Caihong Liu, Di Zhu, Demin Liu, Ling Zhang, Zhen Zhang, Dina Xie, Xiangying Jiao, Wayne Bond Lau, Bernard L. Lopez, Theodore A. Christopher, Xin-Liang Ma, Jimin Cao, Yajing Wang

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Dysregulated adipokine profiles contribute to the pathogenesis of diabetic cardiovascular complications. Endothelial cell (EC) dysfunction, a common pathological alteration in cardiovascular disorders, is exaggerated in diabetes. However, it is unclear whether and how dysregulated adipokines may contribute to diabetic EC dysfunction.

METHODS AND RESULTS: Serum C1q/TNF-Related Protein 5 (CTRP5) were determined in control/diabetes patients, and control/diabetic mice (high-fat diet, HFD). We observed for the first time that serum total CTRP5 was increased, high molecular weight (HMW) form was decreased, but the globular form (gCTRP5) was significantly increased in diabetic patients. These pathological alterations were reproduced in diabetic mice. To …

Racial And Socioeconomic Disparities In Healthcare- And Community-Associated Clostridium Difficile Infection: A Rapid Review, Rutvin Kyada, Amy Leader, Drph, Mph, Rosemary Frasso, Phd, Cph

Master of Public Health Capstone Presentations

Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in the United States and has been termed by the Centers for Disease Control and Prevention as an “urgent threat” in antimicrobial resistance. Traditionally a major healthcare-associated infection, CDIs have become increasingly common in community settings as well. As usage of healthcare services and certain medications are common risk factors for CDI, an individual’s access to such services can impact the CDI burden they experience. Identifying and addressing such disparities is crucial for an equitable healthcare system, but there is a general dearth of literature reviewing sociodemographic disparities …

Covid-19 Medical Papers Have Fewer Women First Authors Than Expected., Jens Peter Andersen, Mathias Wullum Nielsen, Nicole L Simone, Resa E Lewiss, Reshma Jagsi

Department of Radiation Oncology Faculty Papers

The COVID-19 pandemic has resulted in school closures and distancing requirements that have disrupted both work and family life for many. Concerns exist that these disruptions caused by the pandemic may not have influenced men and women researchers equally. Many medical journals have published papers on the pandemic, which were generated by researchers facing the challenges of these disruptions. Here we report the results of an analysis that compared the gender distribution of authors on 1893 medical papers related to the pandemic with that on papers published in the same journals in 2019, for papers with first authors and last …

Journal Club, Zeynep Uzumcu, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline

• Review coronavirus life-cycle
• Review mechanism of action of remdesivir
• Review previous research on remdesivir
• Close reading of article - Methods - Results - Discussion
• Future research
• Implications for our practice