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Distinct Lineage Of Vesiculovirus From Big Brown Bats, United States, Terry Fei Fan Ng, Cindy Driscoll, Maria Paz Carlos, Algernon Prioleau, Robert Schmieder, Bhakti Dwivedi, Jakk Wong, Yunhee Cha, Steven Head, Mya Breitbart, Eric Delwart

Marine Science Faculty Publications

We identified a novel rhabdovirus, American bat vesiculovirus, from postmortem tissue samples from 120 rabies-negative big brown bats with a history of human contact. Five percent of the tested bats were infected with this virus. The extent of zoonotic exposure and possible health effects in humans from this virus are unknown.

Two Boundaries Separate Borrelia Burgdorferi Populations In North America, Gabriele Margos, Jean I. Tsao, Santiago Castillo-Ramirez, Yvette A. Girard, Anne G. Hoen

Dartmouth Scholarship

Understanding the spread of infectious diseases is crucial for implementing effective control measures. For this, it is important to obtain information on the contemporary population structure of a disease agent and to infer the evolutionary processes that may have shaped it. Here, we investigate on a continental scale the population structure of Borrelia burgdorferi, the causative agent of Lyme borreliosis (LB), a tick-borne disease, in North America. We test the hypothesis that the observed d population structure is congruent with recent population expansions and that these were preceded by bottlenecks mostly likely caused by the near extirpation in the 1900s …

A 45-Year-Old Male With Hiv, Kaposi’S Sarcoma, And Squamous Cell Carcinoma Of The Skin, Jascha Rubin, Md, Hasan Bayat, Md

The Medicine Forum

Case

A 45-year-old male with a history of human immunodeficiency virus, (HIV), on highly active antiretroviral therapy (HAART), Kaposi’s sarcoma, and squamous cell carcinoma (SCC) of the right lower extremity complicated by chronic wound formation presented with worsening right leg pain and increasing wound drainage.

The patient described the pain as excruciating, with 10/10 intensity and exacerbated by movement. His wounds began draining purulent material and blood about two weeks prior to presentation. He has had several similar, though milder episodes in the past requiring hospitalization. When the wounds began to have a foul odor, he presented to the hospital. …

A Case Of Pyoderma Gangrenosum, Christopher T. Miller, Md

The Medicine Forum

Case Report

A 60-year-old man with past medical history of hypertension, post-traumatic stress disorder, major depression, hepatic steatosis, chronic kidney disease, and untreated hepatitis C virus (genotype 1b) initially presented to the outpatient primary care clinic with a chief complaint of an extremely painful right lower extremity ulcer that had developed and grown progressively larger after mild trauma against a metal corner 4 months prior to the appointment. He admitted to picking at the granulation tissue that would develop over the ulcer. He was treating the ulcer with antibiotic ointment. On initial exam, the ulcer was about 2x2 cm, located …

Two Cases Of Co-Infection With Babesiosis And Lyme Disease, Anthony Decicco, Md, B. Niluk Peiris, Md, Cecilia Kelly, Md, Michael Latreille, Md, Donald Jungkind, Phd

The Medicine Forum

Case 1

The patient is a 71-year-old female with past medical history significant for hypothyroidism and hyperlipidemia who presented to Thomas Jefferson University Hospital (TJUH) with complaints of myalgias for 6 weeks duration. The patient stated that she had begun an exercise program to lose weight and had subsequently noticed body aches and increased fatigue. She had presented to an outside hospital with these complaints, was told that the etiology was musculoskeletal, and was prescribed naproxen for pain relief. The pain did improve slightly with the naproxen but she noticed a rash and hives after starting the medication and stopped …

Mycobacterium Fortuitum Device Infection With Subsequent Endocarditis, Paurush Shah, Md, Alec Vishnevsky, Md

The Medicine Forum

Case

A 78-year-old female with a past medical history of mild dementia, hypertension, diabetes, coronary artery disease status post automatic implantable cardioverter defibrillator (AICD) for congestive heart failure presented with suspected bacterial endocarditis and AICD lead infection from an outside hospital (OSH). The patient initially presented to the OSH with chest wall tenderness, fevers up to 101° F, chills, decreased appetite, weakness and weight loss. She was diagnosed with a non-ST segment myocardial infarction based on elevated troponin levels without electrocardiogram changes. At the OSH, blood acid fast bacillus (AFB) cultures were checked after routine blood cultures and fungal cultures …

An Indonesian Male With Abdominal Pain And Weight Loss: Abdominal Tuberculosis Presenting With Cervical Lymph Node Enlargement, Leah Duke Kaye, Md, Jayne Littlejohn, Md

The Medicine Forum

Case

A 21-year-old Indonesian male presented with a 6-month history of abdominal pain. The pain was described as a diffuse cramping that was worse with movement and after meals. He reported early satiety, and the pain was improved at rest. Associated with the pain, he reported a seventy pound weight loss, chills, decreased energy, and fatigue over the same time period. He denied nausea, vomiting, fevers, cough, dyspnea, or chest pain.

The patient emigrated from Indonesia to the United States in 2007 and has since had no travel or foreign visitors. He denied incarceration or military duty for both himself …

A 47-Year-Old Female With Shortness Of Breath, Dana Marrero, Md, Kelly Wright, Md

The Medicine Forum

This patient is a 47-year-old female with a history of end-stage liver disease secondary to hepatitis C virus (HCV) complicated by hepatic encephalopathy, obstructive sleep apnea, asthma, and severe peripheral neuropathy who presents to the hospital with complaints of shortness of breath and cough. The patient was recently discharged from an outside hospital 2 days prior to this admission where she was treated for pneumonia and an asthma exacerbation but her symptoms have not improved. She complains of shortness of breath at rest and severely decreased exercise tolerance with dyspnea while walking across the room. Her cough is persistent and …

A Case Series Of Lyme Carditis With Complete Heart Block, Rina Shah, Md, Mitul Kanzaria, Md

The Medicine Forum

Case 1

A 25-year-old Caucasian male with a history of a benign functional heart murmur presented to the emergency department for evaluation of 10 days of dyspnea with minimal exertion, such as walking a few blocks or climbing a flight of steps. Dyspnea was accompanied by moderate, dull, left-sided chest pain, which had been progressively worsening over the previous 3-5 days. The symptoms initially occurred only with exertion, but progressed to last 30-45 minutes after discontinuation of activity. He also noticed palpitations during these episodes, but did not try any remedies for his symptoms. Of note, two weeks prior to …

Jefferson Alumni Bulletin – Volume 61, Number 2, Spring 2012

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Features:

• Cultivating Great Physicians & the Timeless Art of Physical Diagnosis
• Waking Up to a Sleepy Specialty
• Dancing the Hygiene Hustle

Tropical Medicine Training In The Department Of Defense, Rodney L. Coldren, David Brett-Major, Patrick W. Hickey, Eric Garges, Peter J. Weina, Paula Corrigan, Gerald Quinnan

Journal Articles: Epidemiology

No abstract provided.

Symptom Intrusiveness, Chronic Conditions And Health-Related Quality Of Life: Development Of Conceptual And Measurement Models, Jill Marie Monfre

MUSC Theses and Dissertations

Background: The number of patients in the United States living with chronic conditions is increasing as patients are surviving conditions that were previously fatal. This increase in survival has resulted in a shift in the disease burden in the United States from infectious to chronic diseases. Many patients with chronic conditions experience associated symptoms that impact their health-related quality of life more significantly than those without associated symptoms. To enable patients to achieve what they determine to be an acceptable state of wellbeing, health care providers must first be aware of the factors and the relationships among the factors that …

Epidemiology Of Contemporary Seroincident Hiv Infection In The Navy And Marine Corps, David Brett-Major, Shilpa Hakre, Neal A. Naito, Adam Armstrong, Eric A. Bower, Nelson L. Michael, Paul T. Scott

Journal Articles: Epidemiology

Human Immunodeficiency Virus (HIV) infection continues at a steady rate among U.S. Sailors and Marines. This study provides the first service-specific description of HIV infection demographics. All Sailors and Marines identified as HIV infected between January 2005 and August 2010 were included. The project compared personnel and epidemiologic data, and tested reposed sera in the Department of Defense Serum Repository. This group comprised 410 Sailors and 86 Marines, predominantly men. HIV infected Marines were more likely to be foreign born than their Navy counterparts, 42% versus 10%, p < 0.001. Approximately half of the patients had deployed including to the wars in Iraq or Afghanistan. Nearly half of each group was infected by the age of 25. Similar to the U.S. epidemic, Black race was over-represented. Unlike national rates, Hispanic Sailors and Marines were not over-represented. Demographics were distinct for those of specific occupational specialties. Certain ship classes carried lower incidences. Clustering of HIV infection risk occurred around deployment. The Navy and Marine Corps have different patterns of HIV infection, which may merit distinct approaches to prevention. The Navy may have unique targets for prevention efforts to include pipeline training and first assignment as well as particular occupational environments.

Jefferson Alumni Bulletin – Volume 61, Number 1, Winter 2012

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Features:

• The Gift of Time for Patients with Advanced Bile Duct Cancer
• Celiac Disease: Overcoming a Stealth Public Health Menace
• Light Therapy for a Blue Planet and Beyond

Psychiatrists' Knowledge And Attitudes About The Acquired Immune Deficiency Syndrome, Carol L. Alter, M.D., Ellen S. Dickinson, M.D., Greg Miller, M.D.

Jefferson Journal of Psychiatry

Since 1981 the Acquired Immune Deficiency Syndrome (AIDS) has become the primary health care issue in this nation. Psychiatrists have had a central role in caring for AIDS patients: they have been asked to evaluate and treat patients with neuropsychiatric manifestations of AIDS and emotional reactions to the illness itself, as well as to treat those who are fearful of acquiring AIDS. Numerous studies in the literature have explored the physician and lay population's knowledge and attitudes about AIDS. To date no study has addressed these issues in psychiatrists in specific (1- 9).

Most studies suggest that individuals who have …

Commentary: The Hiv-Positive Resident: Questions And More Questions, Marguerite Blythe, Md

Jefferson Journal of Psychiatry

The resident physician who is infected with the human immunodeficiency virus (HIV) faces unique problems. In addition to the difficulties caused by a chronic and lethal disease, HIV-infected physicians-in-training face ethical, educational and practical problems that are unique to the interplay between residency training and the infection.

To date, physicians who have been found to be infected with HIV have faced public discrimination, many with devastating results. Dr. Hacib Aoun, a Venezulean-born cardiologist who contracted AIDS from a boy with leukemia while he was a resident at Johns Hopkins, overcame rumors about how he had contracted the disease only to …

A Decade After Drug Decriminalization: What Can The United States Learn From The Portuguese Model?, Jordan Blair Woods

University of the District of Columbia Law Review

No abstract provided.

The Stress Factor: Exploring The Possibility Of A Psychological Component To Cancer, Bernard M. Edelstein, Md

Jefferson Journal of Psychiatry

As dwellers in the same house, it seems only logical that psyche and soma would be interdependent , that well-being in one would promote health in the other, and that illness in one would soon become manifest in its partner. Yet quantifying this intuitive relationship has long been a difficult task. Establishing a mechanism for disease-heart disease, infectious disease, neoplastic disease which can withstand the scrutiny of experimental rigor, is difficult enough. To introduce a seemingly not quantifiable entity such as psychology in the form of stress or anxiety presents such great complexity that for a long time it seemed …

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor to the Jefferson Journal of Psychiatry.

Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care, Sanjeev Arora, Summers Kalishman, Denise Dion, Dara Som, Karla Thornton, Arthur Bankhurst, Jeanne Boyle, Michelle Harkins, Kathleen Moseley, Glen Murata, Miriam Komaramy, Joanna Katzman, Kathleen Colleran, Paulina Deming, Sean Yutzy

Project ECHO Bibliography

Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas …

The Rhetorics Of Constructing Hiv/Aids In The United States And China: A Comparative Analysis Of Two Online Discussion Forums, Jingwen Zhang

All Theses

This thesis focuses on the cross-cultural comparison of the public rhetorics that construct HIV/AIDS in two online discussion forums from the United States and China. Social constructions of HIV/AIDS have previously been explored in specific countries and cultures; however, comparative studies have rarely been conducted, especially by applying rhetorical cultural analysis focusing on online discourses. Responding to these gaps in research, this study combines two underexplored dimensions -- comparative rhetorical analysis and online discourse -- to show how online communications, metaphors, and topoi identified in discussion forum posts reveal and construct the idea of HIV/AIDS in the public sphere for …

Host And Distribution Lists Of Chiggers (Trombiculidae And Leeuwenhoekiidae), Of North American Wild Vertebrates North Of Mexico, Brianne L. Walters, John O. Whitaker Jr., Nicholas S. Gikas, William J. Wrenn

Harold W. Manter Laboratory of Parasitology: Faculty Publications

Information concerning chiggers found on wild vertebrates of North America north of Mexico is summarized. Included are lists a) of the chiggers organized taxonomically, b) hosts from which each species has been reported, and c) states and provinces with references for each separate record

Rickettsia Parkeri In Gulf Coast Ticks, Southeastern Virginia, Usa, Chelsea L. Wright, Robyn M. Nadolny, Ju Jiang, Allen L. Richards, Daniel E. Sonenshine, Holly D. Gaff, Wayne L. Hynes

Biological Sciences Faculty Publications

We report evidence that Amblyomma maculatum tick populations are well established in southeastern Virginia. We found that 43.1% of the adult Gulf Coast ticks collected in the summer of 2010 carried Rickettsia parkeri, suggesting that persons living in or visiting southeastern Virginia are at risk for infection with this pathogen.

Health Needs Of Hiv-Infected Women In The United States: Insights From The Women Living Positive Survey., Kathleen E Squires, Sally L Hodder, Judith Feinberg, Dawn Averitt Bridge, Staats Abrams, Stephen P Storfer, Judith A Aberg

Department of Medicine Faculty Papers

The objective of this study was to describe attitudes, opinions, and perceived health needs of HIV-infected women in the United States. In this cross-sectional study, women were invited to participate in the Women Living Positive survey, a structured interview instrument with 45 questions. Collected data were deidentified and the margin of error was calculated as four percentage points. Incoming toll-free phone interviews were conducted from December 21, 2006, through March 14, 2007 among subjects recruited from a U.S. national network of AIDS counseling centers. Seven hundred HIV-infected women (43% African American, 28.5% Hispanic, 28.5% Caucasian; median age, 42.5 years) receiving …

Searching For The Soul Of American Medicine : What Three High-Quality, Low-Cost Health Care Systems Can Teach U.S. Policymakers, Benjamin A. Paul

Honors Theses

"The United States health care system is broken." This common refrain has been echoed by policymakers and politicians, Democrats and Republicans, and liberals and conservatives alike. They point to the unacceptably high number of uninsured Americans, out of control costs, and questionable quality as just some of the problems that afflict American health care. Before the passage of the Patient Protection and Affordable Care Act in March, 2010, over 45 million Americans were without health insurance coverage.1 Health care spending currently accounts for 17% of this country‘s gross domestic product. In contrast, most industrialized European countries cover all of their …

Sisters And Smallpox: The Daughters Of Charity As Advocates For The Sick Poor In Nineteenth-Century Los Angeles, Kristine Ashton Gunnell Ph.D.

Vincentian Studies

The Daughters of Charity were “the key provider of social service in [Los Angeles] before 1880,” opening southern California’s first hospital in 1858. They served anyone, regardless of religion and brought different religious and cultural groups together to help people who were sick. During the smallpox epidemics from the 1860s through the 1880s, the Daughters partnered with officials of Los Angeles to treat the poor. Kristine Gunnell explains how the desire to cut costs, theories of containing disease, and racial and class biases led to the city’s initially inhumane treatment of poor patients. Acting as advocates for the poor, the …

Medical Encounter Characteristics Of Hiv Seroconverters In The Us Army And Air Force, 2000–2004, Shilpa Hakre, David Brett-Major, Darrell E. Singer, Robert J. O'Connell, Warren B. Sateren, Jose L. Sanchez, Brian K. Agan, Nelson L. Michael, Paul T. Scott

Journal Articles: Epidemiology

BACKGROUND AND METHODS: Active duty US Army and Air Force military personnel undergo mandatory biennial HIV antibody screening. We compared pre- and post-HIV seroconversion health status by conducting a case-control study, which evaluated all medical encounters and sociodemographic factors among incident HIV seroconverters and HIV-negative controls from June 2000 through February 2004.

RESULTS: A total of 274 HIV seroconverters and 6205 HIV-negative personnel were included. In multivariate analysis restricted to male personnel (cases = 261, controls = 5801), single marital status (adjusted odds ratio [AOR] = 14.37), clinical indicators or symptoms within four years of HIV diagnosis (AOR = 6.22), …

A Comparison Of Healthcare Between Nicaragua And The United States And The Feasibility Of Naturopathic Medicine, Alyssa Neph

Honors Projects

No abstract provided.

A Comparison Of Pharmacist Travel-Health Specialists' Versus Primary Care Providers' Recommendations For Travel-Related Medications, Vaccinations, And Patient Compliance In A College Health Setting, Melissa J. Durham, Jeffery A. Goad, Lawrence S. Neinstein, Mimi Lou

Pharmacy Faculty Articles and Research

Background. Pretravel medication and vaccination recommendations and receipt were compared between primary care providers (PCPs) without special training and clinical pharmacists specializing in pretravel health.

Methods. A retrospective chart review of patients seen for pretravel health services in a pharmacist-run travel clinic (PTC) compared to PCPs at a University Student Health Center. Vaccine/medication recommendations were assessed for consistency with national/international guidelines. Medical/pharmacy records were queried to determine the receipt of medications/vaccinations.

Results. The PTC recommended antibiotics for travelers' diarrhea were given more often when indicated (96% vs 50%, p < 0.0001), and patients seen in the PTC received their medications more often (75% vs 63%, p = 0.04). PCPs prescribed more antibiotics for travelers' diarrhea that were inconsistent with guidelines (not ordered when indicated 49% vs 6%, p < 0.0001 and ordered when not indicated 21% vs 3%, p < 0.0001). The PTC prescribed antimalarials more often when indicated (98% vs 81%, p < 0.0001), while PCPs prescribed more antimalarials that were inconsistent with guidelines (not ordered when indicated 15% vs 1%, p < 0.0001 and ordered when not indicated 19% vs 2%, p < 0.0001). The PTC ordered more vaccines per patient when indicated (mean = 2.77 vs 2.31, p = 0.0012). PTC patients were more likely to receive vaccines when ordered (mean = 2.38 vs 1.95, p = 0.0039). PCPs recommended more vaccines per patient that were inconsistent with guidelines (not ordered when indicated: mean = 0.78 vs 0.12, p < 0.0001, ordered when not indicated: mean 0.18 vs 0.025, p < 0.0001).

Conclusions. A pharmacist-run pretravel health clinic can …

Biodefense And Constitutional Constraints, Laura K. Donohue

Georgetown Law Faculty Publications and Other Works

The United States and United Kingdom have different approaches to quarantine law that reflect each country’s unique historical context and constitutional structure. Under the Tudors, England vested quarantine authority in the monarch, with its subsequent exercise conducted by the military. As the constitutional structure changed, the manner in which quarantine was given effect subtly shifted, leading to constitutional reforms. Authorities transferred first to the Privy Council and, subsequently, to Parliament, where commercial interests successfully lobbied them out of existence. By the end of the 19th Century, quarantine authorities had been pushed down to the local port authorities. In the United …