Digital Commons Network^™

Exploring Sex-Specific Clinical Features In Chinese Patients With Takotsubo Syndrome, Hong-Yi Duan, Ling-Lin Wang, Ling-Chun Lyu, Zhen-Hua Shi, Xiao-Ping Lin, Zheng-Yang Yu, Guo-Hua Fan, Jing Chen, Xin-Hong Yang, Wei Deng, Chang-Wu Xu, Yan Huang, Qing Zhou, Jin-Ling Chen, Hong-Ning Song, Dong Hu, Jin-Qiu Liu, Hector Barajas-Martinez, Charles Antzelevitch, Kan Liu, Hong Jiang, Dan Hu

Department of Medicine Faculty Papers

BACKGROUND: Takotsubo syndrome (TTS) is considered as a transient acute heart failure syndrome predominant in females. However, data on Chinese TTS patients are limited. Therefore, this study aimed to investigate the clinical characteristics of Chinese TTS patients, identify prognostic markers.

METHODS: A total of 258 TTS patients were enrolled. Data on clinical characteristics and in-hospital major adverse cardiovascular events (MACE) were collected and analyzed. The latter included severe heart failure, shock, malignant arrhythmia, and death.

RESULTS: The average age of TTS patients was 59.3 ± 19.2 years. Female patients accounted for 68.9%. MACE occurred in 41.4% of patients during hospitalization. …

From Er To Mortality In 48 Hours: A Fatal Case Of Overwhelming Post-Splenectomy Infection, Miriam Stern, Ba, Blaise O’Malley, Bs, Amry Majeed, Md, Michael Grodsky, Md

The Medicine Forum

Overwhelming post-splenectomy infection (OPSI) is a known complication of asplenia.^1,2 While the precise rates of morbidity and mortality are unknown, estimates range from 38% to as high as 70%.² Because the spleen plays an important role in protecting against infections with encapsulated microorganisms, OPSI is most commonly caused by infection with encapsulated bacteria, specifically Streptococcus pneumoniae.^1–3 While pneumococcal vaccines have been shown to improve immunogenicity in asplenic people, OPSI remains a danger to both vaccinated and unvaccinated patients.^4,5 Additional measures to protect asplenic patients from overwhelming infection have been proposed, but the evidence remains mixed. …

String Theory - A Case Of Hypermucoviscous Klebsiella Pneumoniae Causing Distant Necrotizing Infections, Natasa Kostic, Md, Marina Gonzalez, Md

The Medicine Forum

Klebsiella pneumoniae is a Gram-negative, encapsulated bacterium belonging to the Enterobacteriaceae family. It is more frequently associated with nosocomial infections and is one of several bacteria developing high rates of antibiotic resistance.¹ Since the mid-1980s, there have been reported cases of Klebsiella pneumoniae causing life-threatening, invasive infections acquired in the community by otherwise healthy individuals. The propensity to form metastatic foci of infection in immunocompetent hosts is unusual for an enteric, Gram-negative pathogen.² This hypervirulent variant of K. pneumoniae was originally noted only in Asian-Pacific countries but is now being identified globally.³ The variant has unique mucoid …

Negative Urine Nucleic Acid Amplification Testing In A Case Of Disseminated Gonococcal Infection Presenting As Migratory Arthritis, Benjamin Richter, Md

The Medicine Forum

Disseminated gonococcal infection (DGI) is a well-documented complication of Neisseria gonorrhoeae infection, most characteristically presenting as migratory arthritis, tenosynovitis, and dermatitis. Although modern nucleic acid amplification tests (NAATs) and cultures from mucosal sites have significantly improved diagnostic capabilities, discrepancies between clinical manifestations and laboratory findings still occur.¹ One such challenge arises when the urine gonorrhea test returns negative despite strong clinical evidence pointing toward gonococcal involvement.

Migratory arthritis—a transient, shifting pattern of joint inflammation—has long been recognized as a hallmark of DGI.² Typically, the pathogen is detected in blood, synovial fluid, or from mucosal specimens; however, negative urine …

From Cure To Crisis: A Case Of Severe Hypoxic Respiratory Failure Due To Daptomycin-Associated Eosinophilic Pneumonitis, Muneeba Ali, Md, Enad Haddad, Md, Warda Naqvi, Md, Conrad Reed, Md

The Medicine Forum

Daptomycin is a cyclic lipopeptide antibiotic that commonly treats Gram-positive infections. Most frequently prescribed for osteoarticular infections.¹ Daptomycin is associated with numerous side effects, including myopathy, rhabdomyolysis, eosinophilic pneumonia, and anaphylactic hypersensitivity reactions.1 Daptomycin-induced eosinophilic pneumonitis (DIEP) is a rare but potentially life-threatening adverse effect associated with prolonged use.² There are several established criteria for diagnosing this medical condition. However, the variation in its clinical presentation, coupled with the favorable outcomes of early diagnosis and the severe consequences of delayed diagnosis, emphasizes the need for further discussions. This case highlights the importance of monitoring patients on prolonged daptomycin …

A Patient With Recently Diagnosed Hiv Found To Have Cryptococcus Meningitis With Course Complicated By Pneumocystis Jirovecii Pneumonia, Cmv Colitis, And Kaposi Sarcoma, Benjamin Richter, Md

The Medicine Forum

Opportunistic infections (OIs) remain a major cause of morbidity and mortality in individuals with advanced human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), particularly in those with severe immunosuppression. Among the most life-threatening OIs are cryptococcal meningitis, Pneumocystis jirovecii pneumonia (PJP), cytomegalovirus (CMV) colitis, and Kaposi sarcoma (KS), each of which poses significant diagnostic and therapeutic challenges.

Here is a case of a man with recently diagnosed HIV who was admitted to the hospital with a chief complaint of headache and was found to have cryptococcal meningitis with a hospital course complicated by Pneumocystis jirovecii pneumonia (PJP), CMV colitis, and Kaposi sarcoma. …

A Case Of Varicella Zoster Virus Meningitis Presenting As Idiopathic Vocal Fold Paralysis, Dustin Sneed, Md, M. D. Kilpatrick, Md, Alicia Bao, Md

The Medicine Forum

The typical presentation of a patient with herpes zoster, the reactivation of varicella zoster virus (VZV), involves a painful dermatomal vesicular rash known as shingles. However, as the following case demonstrates, VZV reactivation can present with atypical symptoms, sometimes without the characteristic rash. This presentation is known as zoster sine herpete. This case focuses on a patient presenting with dysphagia and dysphonia, who was diagnosed with VZV meningitis with suspected laryngeal involvement. We discuss workup and treatment for this disease, and the importance of a wide differential and multidisciplinary consultation to improve patient outcomes.

Complexities In Alcoholic Necrotizing Pancreatitis: A Case Report Of Severe Vascular And Infectious Complications, Dawood Tahir, Md, Shravya Ginnaram, Md, Jacob Lipkin, Md

The Medicine Forum

Acute pancreatitis (AP) incidence has been increasing, with an annual incidence of approximately 5 to 40 cases per 100,000.¹ Several complications occur with AP, including splanchnic vein thrombosis (SVT), pseudocyst, and pseudoaneurysm (PSA). Moreover, 15-20% of patients develop necrotizing pancreatitis (NP) following an episode of AP with a mortality rate of up to 32%,² which can be further complicated by infected necrosis in up to one-third of patients.² Hemorrhage is estimated to occur in less than 6% of patients with NP by pseudoaneurysm.³ The endoscopic step-up approach is the standard treatment for walled-off necrosis, whereas alternative …

Table Of Contents: The Medicine Forum, Volume 26, 2024-2025

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 26, 2024-2025

The Medicine Forum: Volume 26

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 26, 2024-2025

TABLE OF CONTENTS

• Research Studies
• Case Reports
• Humanities & Reflections

The Effect Of Sars-Cov-2 Reinfection On Long-Term Symptoms In The Innovative Support For Patients With Sars-Cov-2 Infections Registry (Inspire), John J. Openshaw, Ji Chen, Robert Rodriguez, Michael Gottlieb, Kalyani Mccullough, Michelle Santangelo, Mandy J. Hill, Kristyn Gatling, Ahamed H. Idris, Samuel Mcdonald, Lauren E. Wisk, Jonathan Dyal, Ralph C. Wang, Kristin L. Rising, Efrat Kean, Kelli N. O'Laughlin, Kari A. Stephens, Caitlin Malicki, Zhenqiu Lin, Erica S. Spatz, Huihui Yu, Robert A. Weinstein, Joann Elmore

Department of Emergency Medicine Faculty Papers

BACKGROUND: The clinical consequences of repeated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not clear, especially as they relate to long-term symptoms after infection. We analyzed data collected for the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) to determine whether reinfection changes the likelihood of symptoms 3-6 months after reinfection compared with the likelihood in individuals experiencing a single infection.

METHODS: Individuals reporting a single SARS-CoV-2 infection or a single reinfection were included in this analysis. A positive SARS-CoV-2 test occurring ≥90 days after a first infection was considered a reinfection. Outcomes included severe fatigue (fatigue …

Who Seeks Help? A Sociodemographic Analysis Of Cannabis Use Disorder Treatment In New York, Ayodele Atolagbe, Ekenedilichukwu Theresa Emembolu, Stanley Nkemjika

Department of Psychiatry and Human Behavior Faculty Papers

Introduction: Cannabis use disorder (CUD) is being increasingly diagnosed in the United States, but access to treatment remains unequal, particularly in New York. Identifying the factors that contribute to disparities in receiving treatment for CUD among different population groups is essential for ensuring effective and targeted interventions. This study explores the sociodemographic factors influencing treatment utilization for CUD in New York.

Methods: Data for this study were retrieved from the 2018 Treatment Episode Data Set—Discharges (TEDS-D) of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Sample size for the study is 422,319 people with CUD. Logistic regression analysis …

Development And Mechanistic Investigation Of Recombinant Type Iii Humanized Collagen Gel For Mid-Facial Soft Tissue Repair, Qian Wang, Qifei An, Yuanzhou Wang, Jingbo Yang, Xiujuan Zhang, Shibo Jiang, Min Chen, Lu Lu, Yun Zhu

Center for Translational Medicine Faculty Papers

Mid-facial depression is a key sign of facial aging, primarily caused by the loss of collagen leading to depletion of the extracellular matrix (ECM). However, the existing fillers for soft tissue augmentation have shown certain limitations in repairing mid-facial depression. Therefore, we herein report the development of a novel recombinant humanized type III collagen gel (C3Gel) through rational design and modification of a commercially available recombinant type III humanized collagen lyophilized fiber product. Both biological activity and tissue repair mechanisms of C3Gel were systematically evaluated in vitro and in vivo. C3Gel formed a dense fibrous structure around cells, significantly improving …

Protecting The Future Of Medical Innovation: Balancing Fiscal Responsibility With The Need For National Institutes Of Health And Federal Health Funding, Irina Petrache, Raed A. Dweik, Michelle Ng Gong, Jesse Roman, M. Patricia Rivera, Karen J. Collishaw

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Association Of Sars-Cov-2 With Health-Related Quality Of Life 1 Year After Illness Using Latent Transition Analysis, Lauren Wisk, Michael Gottlieb, Peizheng Chen, Huihui Yu, Kelli O'Laughlin, Kari Stephens, Graham Nichol, Juan Carlos Montoy, Robert Rodriguez, Michelle Santangelo, Kristyn Gatling, Erica Spatz, Arjun Venkatesh, Kristin Rising, Mandy Hill, Ryan Huebinger, Ahamed Idris, Michael Willis, Efrat Kean, Samuel Mcdonald, Joann Elmore, Robert Weinstein

Department of Emergency Medicine Faculty Papers

BACKGROUND: Long-term sequelae after SARS-CoV-2 infection may impact health-related quality-of-life (HRQoL), yet it is unknown how HRQoL changes during recovery. We compared patient-reported HRQoL among adults with COVID-19-like illness who tested SARS-CoV-2 positive (COVID+) with those who tested negative (COVID-).

METHODS: Participants in this prospective, multicenter, longitudinal registry study were enrolled from December 2020 through August 2022 and completed 3-month follow-up assessments until 12 months after enrollment. Participants were adults (≥18 years) with acute symptoms suggestive of COVID-19 who received a Food and Drug Administration-approved SARS-CoV-2 test. Participants received questions from PROMIS-29 (subscales: physical function, anxiety, depression, fatigue, social participation, …

A Smart Pill Bottle And Text Messaging Intervention For Promoting Medication Adherence In Patients With Chronic Myeloid Leukemia: A Pilot Study Of Txt4 Tki, Kuang-Yi Wen, Neil Palmisiano, Rita Smith, Rachel Slamon, Gina Keiffer, Christian Fidler, Margaret Kasner, Lindsay Wilde, Md

Department of Medical Oncology Faculty Papers

BACKGROUND: Patients undergoing tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia (CML) often face challenges with adherence, despite the efficacy of the treatment. Theory-guided and evidence-informed interventions addressing psychosocial and adherence barriers are critical for promoting adherence. Using a mixed-method approach, the pilot study developed and evaluated the feasibility and potential impact of an intervention "txt4TKI," to support medication and symptom management among CML patients undergoing TKI therapy.

METHODS: Guided by the Necessity and Concerns framework, the study comprised two phases: Phase 1 involved qualitative patient needs assessment interviews informing intervention design. Phase 2 was a single-arm pilot study …

Evaluation Of Knowledge, Attitudes And Vaccine Hesitancy Towards Mmr Vaccine Among Parents In The United Arab Emirates, Kamel A. Samara, Hiba Jawdat Barqawi, Deema M. Alhayali, Samah Mohamed Kannas, Rim M. Elmorsy, Eman Abu-Gharbieh

Abington Jefferson Health Papers

BACKGROUND: The Measles, Mumps, and Rubella (MMR) vaccine is highly effective, but vaccine hesitancy (VH) is a key barrier to achieving herd immunity. This study aims to assess the general attitudes and knowledge of UAE parents regarding measles and the MMR vaccine while identifying determinants of VH.

METHODOLOGY: A cross-sectional study was done from 15th April 2024 and 5th June 2024. This study recruited 462 parents residing in the UAE using convenience sampling. Recruitment occurred through various social media platforms including WhatsApp, X, and Instagram, as well as in public by approaching parents in parks and malls. Information collected included …

Tacrolimus Dosing In Liver Transplant Recipients Using Phenotypic Personalized Medicine: A Phase 2 Randomized Clinical Trial, Jeffrey Khong, Megan Lee, Curtis Warren, Un Kim, Sergio Duarte, Kenneth Andreoni, Sunaina Shrestha, Mark Johnson, Narendra Battula, Danielle Mckimmy, Thiago Beduschi, Ji-Hyun Lee, Derek Li, Chih-Ming Ho, Ali Zarrinpar

Department of Surgery Faculty Papers

Tacrolimus is the most commonly used immunosuppression drug after solid organ transplantation; however, its dosing is challenging due to substantial inter-individual variability, often resulting in blood levels that deviate from the target therapeutic range. We explored whether a dynamically customized, phenotypic-outcome-guided drug dosing method could improve maintenance of drug trough levels within pre-determined target ranges, focusing on tacrolimus immediately after liver transplantation. This single-center, partially blinded, completed clinical trial involved 62 adults undergoing liver transplantation, block randomized into parallel groups: standard-of-care (SOC) clinician-determined or Phenotypic Personalized Medicine (PPM)-guided tacrolimus dosing. The primary outcome was percentage of post-transplant days with large …

Improving Guideline-Based Prep Management In A Philadelphia-Based Academic Family Medicine Office, Brittany Macdonald, Md, Marshall Miller, Md, Nwando Ekezie, Md, Maia Mandel, Md, Christina Boras, Md, Eunice Choe, Md, Meghan Swyryn, Md, Meg Broderick, Md, Pascaline Karanja, Md, Julia Beatini, Md, Julie Jones

Health Equity and Quality Improvement (HEQI) Summit

Background

Pre-Exposure Prophylaxis (PrEP) significantly reduces the risk of contracting HIV:

• Reduces risk from sexual contact by 99%
• Reduces risk from injection drug use by at least 74%

Despite its effectiveness, PrEP is underutilized in the USA.

• In 2019, an estimated 224,000 Americans received a prescription for PrEP despite 1.1 million people having indications for PrEP.
• Lack of provider knowledge surrounding PrEP clinical guidelines is a common reason for underutilization.

Enhancing Patient Education Of Antimicrobial Side Effects At Discharge, Isaac Daudelin, Md, Phd, Bojan Lazarevic, Jordan Feingold-Link, Md, Nehar Damle, Md, Pharmd, Caroline Brugger, Crnp, Rachel Carr, Pa-C, Devin Weber, Md, Daniel Taupin, Md, Mhqs

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem: Patients discharged from the hospital on antimicrobial agents often receive insufficient education about potential side effects that warrant medical attention(1). We identified a critical gap in patient communication and safety that occurred during discharge at a large urban academic center.

Stakeholders

• Patients
• Physicians
• Nurses
• Pharmacists
• Outpatient providers
• Nurse practitioners
• Physician assistants

Objective: This project aimed to utilize a multidisciplinary team to:

1. Quantify a gap in patient education
2. Create an interactive navigator- which would not rely on provider memory and automatically include relevant information in patient discharge paperwork
3. Implement within 3 months into the EPIC system
4. Measure the effect …

Quantiferon Tb Gold Test Utilization During Inpatient And Emergency Department Encounters At A Multi-Site, Single Academic Institution, Laxman Singanamala, Bs, Laura Walters, Do, Devin M. Weber, Md, Courtney E. Comar, Phd

Health Equity and Quality Improvement (HEQI) Summit

Background

• The QuantiFERON-TB Gold Plus test (QG) is an in vitro Interferon Gamma Release Assay that can be used to assess for prior exposure to Mycobacterium tuberculosis (MTB). The optimal use is in screening for latent disease.
• The United States is a low endemic country for MTB infection with 2.5 cases/100,000-persons in 2022 (CDC). Yet, we noted high utilization of the QG in our institution.
• Our goal was to understand our patient population and the clinical rationale for testing to create an electronic medical record (EMR) order set to optimize appropriate test use, decreasing unnecessary testing for patients and healthcare …

Viral Hepatitis And Hiv Screening Amongst Inpatients With Substance Use Disorder: An Initial Pdsa Cycle Analysis, Christine Papastamelos, Md, Elizabeth Novick, Md, Carolyn Kramer, Md, John Zurlo, Md, Nikhil Seval, Md, Mollie Tucker, Md, Daniel Taupin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• ~67,000 individuals in Philadelphia county are estimated to be living with substance use disorder (SUD).¹
• Persons who inject drugs (PWID) are at disproportionately higher risk of acquiring HIV and viral hepatitis compared to the general public.² 
• A 3-month retrospective chart review (11/6/23-1/22/24) of 160 inpatient SUD encounters with an Infectious Disease (ID) consult showed that 35%-42% of HIV and hepatitis C screening opportunities were missed.

Readmission For Picc Line Placement In Spine Surgery, Joseph Schaefer, Md, Joshua Heller, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Pseudoarthrosis is failure of adequate bony fusion after a spinal fusion
• Prior literature has implicated occult C. acnes infection in cases of pseudoarthrosis
• Intraoperative cultures are often sent in cases of pseudoarthrosis at Jefferson
• C. acnes cultures often result after discharge requiring readmission

Causes Of Death Among Us Medical Residents, Nicholas A. Yaghmour, William E. Bynum, Frederic W. Hafferty, Karen D. Könings, Thomas Richter, Timothy P. Brigham, Thomas J. Nasca

Division of Nephrology Faculty Papers

IMPORTANCE: From 2000 to 2014, the leading causes of medical resident death in the United States were neoplastic diseases and suicide.

OBJECTIVE: To examine whether US medical resident rates of death have changed since 2014 and whether causes of resident death differ by specialty.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, residents and fellows who were enrolled in Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs and who died from January 2015 to December 2021 were submitted to the National Death Index to obtain causes of death. These decedents were compared with residents and fellows who died between …

Characterising Acute And Chronic Care Needs: Insights From The Global Burden Of Disease Study 2019, A. A. Asadi-Pooya

Department of Neurology Faculty Papers

Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic …

Editorial–Special Issue On Application Of Cold Atmospheric Plasma In Human And Veterinary Disease, Katharina Stapelmann, Eloisa Sardella, Vandana Miller

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Plasma medicine is a rapidly evolving interdisciplinary field that combines plasma science and engineering, chemistry, biology, and medicine. This special issue focuses on various ways to apply cold atmospheric pressure plasma in translating plasma technology into clinical applications. Ongoing research on the redox-based mechanism of plasma action, the concept of 'plasma dose' and device control is critical for advancing plasma medicine. As these applications move toward the clinic, ensuring the reproducibility and quality control of plasma sources is essential. The articles in this issue present examples of both direct and indirect plasma applications, with indirect treatments describing cell exposure to …

Alphamissense Predictions And Clinvar Annotations: A Deep Learning Approach To Uveal Melanoma, David J. Taylor Gonzalez, Mak B. Djulbegovic, Meghan Sharma, Michael Antonietti, Colin K. Kim, Vladimir N. Uversky, Carol L. Karp, Carol L. Shields, Matthew W. Wilson

Wills Eye Hospital Papers

OBJECTIVE: Uveal melanoma (UM) poses significant diagnostic and prognostic challenges due to its variable genetic landscape. We explore the use of a novel deep learning tool to assess the functional impact of genetic mutations in UM.

DESIGN: A cross-sectional bioinformatics exploratory data analysis of genetic mutations from UM cases.

SUBJECTS: Genetic data from patients diagnosed with UM were analyzed, explicitly focusing on missense mutations sourced from the Catalogue of Somatic Mutations in Cancer (COSMIC) database.

METHODS: We identified missense mutations frequently observed in UM using the COSMIC database, assessed their potential pathogenicity using AlphaMissense, and visualized mutations using AlphaFold. Clinical …

Spectrum Of Congenital Anomalies Detected Through Anatomy Ultrasound At A Referral Hospital In Ghana, Alim Swarray-Deen, Morgan Yapundich, Sarah Boudova, Kwaku Doffour-Dapaah, Jeff Osei-Agyapong, Perez Sepenu, Alex K. Boateng, Teresa A. Mensah, Patrick Anum, Nana Essuman Oduro, Theophilus Adu-Bredu, Promise E. Sefogah, Jerry Coleman, Samuel A. Oppong

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Africa has a high burden of congenital anomalies due in part to limited preconception care, infections, and environmental exposures. However, the true prevalence of congenital anomalies is unclear because of insufficient access to prenatal diagnostic services. We aimed to determine the rate of congenital anomalies, and characterize the anomalies detected prenatally at a referral hospital in Ghana.

METHODS: We performed a four-year retrospective review of all fetal anomaly ultrasounds performed and congenital anomalies detected from January 1st, 2020, to December 31st, 2023, at Korle Bu Teaching Hospital, Accra, Ghana. Data were extracted from the electronic database on maternal age, …

Use Of Procalcitonin In Therapeutic Decisions In The Pediatric Intensive Care Unit, Pierre Tissières, Elisabeth Esteban Torné, Johannes Hübner, Adrienne Randolph, Corsino Rey Galán, Scott Weiss

Department of Medicine Faculty Papers

Procalcitonin (PCT) is frequently used by clinicians in children with suspected bacterial infections and sepsis. However interpretation in the critically ill child may be challenging due to the complexity of underlying conditions and its impact on PCT values. Herein, we propose a guidance for the use of procalcitonin in critically ill children, supported by a comprehensive analysis of the literature, to help the clinician for interpreting PCT in the various clinical conditions encountered in pediatric intensive care units. We describe the importance of the clinical context, timing of measurement and evidence on PCT values in diagnosing sepsis and to guide …

Evolution Of The Tumor Immune Landscape During Treatment With Tebentafusp, A T Cell Receptor-Cd3 Bispecific, Joseph Sacco, Peter Kirk, Emma Leach, Alexander Shoushtari, Richard Carvajal, Camille Britton-Rivet, Sophie Khakoo, Laura Collins, Luis De La Cruz-Merino, Zeynep Eroglu, Alexandra Ikeguchi, Paul Nathan, Omid Hamid, Marcus Butler, Sarah Stanhope, Koustubh Ranade, Takami Sato

Department of Medical Oncology Faculty Papers

Metastatic uveal melanoma is an aggressive disease with poor outcome, which is refractory to immune checkpoint inhibitors. A T cell receptor (TCR)-based CD3 bispecific, tebentafusp, delivers clinical benefit in patients with metastatic uveal melanoma. Understanding the molecular basis for the anti-tumor activity of tebentafusp in an indication where checkpoint inhibitors are ineffective could aid in identification of other solid tumor indications where CD3 bispecifics may serve an unmet need. By analyzing tumor biopsies taken prior to treatment, early on-treatment, and at progression (NCT02570308), using RNA sequencing (RNA-seq) and immunohistochemistry (IHC), we show that expression of interferon-related genes in the tumor …