Medicine and Health Sciences Commons^™

Chasing The Dragon: A Case Of Inhaled Heroin Overdose Resulting In Stunned Myocardium, Neiman Ramjattan Do

Department of Medicine

No abstract provided.

Bouveret’S Syndrome: Definitive Diagnosis With Esophagogastroduodenoscopy, Patrick Hickey Do, Matthew Sullivan Do, Saba Ahmad Md, James Cornell Md, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Recurrent Biliary Obstruction Overcome With Metal Biliary Stent Placement In The Surgically Altered Down Syndrome Patient For Congenital Duodenal Atresia, Patrick Hickey Do, Matthew Sullivan Do, Saba Ahmad Md, Hiral Shah Md

Department of Medicine

No abstract provided.

Adenomyomatous Hyperplasia Of The Ampulla Of Vater Masquerading As Malignancy: A Case Series, Patrick Hickey Do, Saba Ahmad Md, Matthew Sullivan Do, Miriam L. Enriquez Md, Jeffrey Brodsky Md, Hiral Shah Md

Department of Medicine

No abstract provided.

The Cost Of Moving Optimally: Kinematic Path Selection., Dinant A Kistemaker, Jeremy D Wong, Paul L Gribble

Brain and Mind Institute Researchers' Publications

It is currently unclear whether the brain plans movement kinematics explicitly or whether movement paths arise implicitly through optimization of a cost function that takes into account control and/or dynamic variables. Several cost functions are proposed in the literature that are very different in nature (e.g., control effort, torque change, and jerk), yet each can predict common movement characteristics. We set out to disentangle predictions of the different variables using a combination of modeling and empirical studies. Subjects performed goal-directed arm movements in a force field (FF) in combination with visual perturbations of seen hand position. This FF was designed …

Temporal And Stochastic Control Of Staphylococcus Aureus Biofilm Development., Derek E. Moormeier, Jeffrey L. Bose, Alexander R. Horswill, Kenneth W. Bayles

Journal Articles: Pathology and Microbiology

Biofilm communities contain distinct microniches that result in metabolic heterogeneity and variability in gene expression. Previously, these niches were visualized within Staphylococcus aureus biofilms by observing differential expression of the cid and lrg operons during tower formation. In the present study, we examined early biofilm development and identified two new stages (designated "multiplication" and "exodus") that were associated with changes in matrix composition and a distinct reorganization of the cells as the biofilm matured. The initial attachment and multiplication stages were shown to be protease sensitive but independent of most cell surface-associated proteins. Interestingly, after 6 h of growth, an …

Mechanisms Of Ash Resistance To Emerald Ash Borer: Progress And Gaps, Caterina Villari, Justin G.A. Whitehill, Don Cipollini, Daniel A. Herms, Pierluigi Bonello

Biological Sciences Faculty Publications

The emerald ash borer (EAB) invasion of North America has caused widespread mortality of native ash, and is threatening the native ash resources. As a consequence of its devastating impact, EAB has caught the attention of the scientific community, and several studies have focused on different aspects of the biology and behavior of this pest, including its interaction with host defenses. Here we present a review of the published literature on mechanisms of ash resistance to EAB, the understanding of which, despite starting from a tabula rasa, has achieved significant progress in the last few years.

Mmu-Mir-615-3p Regulates Lipoapoptosis By Inhibiting C/Ebp Homologous Protein., Yasuhiro Miyamoto, Amy S Mauer, Swarup Kumar, Justin L. Mott, Harmeet Malhi

Journal Articles: Biochemistry & Molecular Biology

Lipoapoptosis occurring due to an excess of saturated free fatty acids such as palmitate is a key pathogenic event in the initiation of nonalcoholic fatty liver disease. Palmitate loading of cells activates the endoplasmic reticulum stress response, including induction of the proapoptotic transcription factor C/EBP homologous protein (CHOP). Furthermore, the loss of microRNAs is implicated in regulating apoptosis under conditions of endoplasmic reticulum (ER) stress. The aim of this study was to identify specific microRNAs regulating CHOP expression during palmitate-induced ER stress. Five microRNAs were repressed under palmitate-induced endoplasmic reticulum stress conditions in hepatocyte cell lines (miR-92b-3p, miR-328-3p, miR-484, miR-574-5p, …

Assessment Of Anthelmintic Efficacy Of Mebendazole In School Children In Six Countries Where Soil-Transmitted Helminths Are Endemic, Bruno Levecke, Antonio Montresor, Marco Albonico, Shaali M. Ame, Jerzy M. Behnke, Jeffrey M. Bethony, +15 Additional Authors

Microbiology, Immunology, and Tropical Medicine Faculty Publications

BACKGROUND:

Robust reference values for fecal egg count reduction (FECR) rates of the most widely used anthelmintic drugs in preventive chemotherapy (PC) programs for controlling soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, and hookworm) are still lacking. However, they are urgently needed to ensure detection of reduced efficacies that are predicted to occur due to growing drug pressure. Here, using a standardized methodology, we assessed the FECR rate of a single oral dose of mebendazole (MEB; 500 mg) against STHs in six trials in school children in different locations around the world. Our results are compared with those previously obtained …

Mirror Reversal And Visual Rotation Are Learned And Consolidated Via Separate Mechanisms: Recalibrating Or Learning De Novo?, Sebastian Telgen, Darius Parvin, Jörn Diedrichsen

Brain and Mind Institute Researchers' Publications

Motor learning tasks are often classified into adaptation tasks, which involve the recalibration of an existing control policy (the mapping that determines both feedforward and feedback commands), and skill-learning tasks, requiring the acquisition of new control policies. We show here that this distinction also applies to two different visuomotor transformations during reaching in humans: Mirror-reversal (left-right reversal over a mid-sagittal axis) of visual feedback versus rotation of visual feedback around the movement origin. During mirror-reversal learning, correct movement initiation (feedforward commands) and online corrections (feedback responses) were only generated at longer latencies. The earliest responses were directed into a nonmirrored …

Targeting The Small- And Intermediate Conductance Ca2+- Activated Potassium Channels: The Drug Binding Pocket At The Channel/Calmodulin Interface, Meng Cui, Guangrong Qin, Kunqian Yu, M. Scott Bowers, Miao Zhang

Pharmacy Faculty Articles and Research

The small- and intermediate-conductance Ca 2+ -activated potassium (SK/IK) channels play important roles in the regulation of excitable cells in both the central nervous and cardiovascular systems. Evidence from animal models has implicated SK/IK channels in neurological conditions such as ataxia and alcohol use disorders. Further, genome-wide association studies have suggested that cardiovascular abnormalities such as arrhythmias and hypertension are associated with single nucleotide polymorphisms that occur within the genes encoding the SK/IK channels. The Ca 2+ sensitivity of the SK/IK channels stems from a constitutively bound Ca 2+ -binding protein: calmodulin. Small-molecule positive modulators of SK/IK channels have been …

Using Locally Derived Seroprevalence Data On Measles, Mumps, Rubella And Varicella By Birth Cohort To Determine Risks For Vaccine Preventable Diseases During International Travel, Gisela Rosario Md, Marcelo Gareca Md, Hope Kincaid Mph, Cph, Mark Knouse Md

Department of Medicine

No abstract provided.

Smarter Vaccine Design Will Circumvent Regulatory T Cell-Mediated Evasion In Chronic Hiv And Hcv Infection, Leonard Moise, Frances Terry, Andres H. Gutierrez, Ryan Tassone, Phyllis Losikoff, Stephen H. Gregory, Chris Bailey-Kellogg

Dartmouth Scholarship

Despite years of research, vaccines against HIV and HCV are not yet available, due largely to effective viral immunoevasive mechanisms. A novel escape mechanism observed in viruses that cause chronic infection is suppression of viral-specific effector CD4(+) and CD8(+) T cells by stimulating regulatory T cells (Tregs) educated on host sequences during tolerance induction. Viral class II MHC epitopes that share a T cell receptor (TCR)-face with host epitopes may activate Tregs capable of suppressing protective responses. We designed an immunoinformatic algorithm, JanusMatrix, to identify such epitopes and discovered that among human-host viruses, chronic viruses appear more human-like than viruses …

Analysis Of Candida Albicans Mutants Defective In The Cdk8 Module Of Mediator Reveal Links Between Metabolism And Biofilm Formation, Allia K. Lindsay, Diana K. Morales, Zhongle Liu, Nora Grahl, Anda Zhang, Sven D. Willger, Lawrence C. Myers, Deborah A. Hogan

Dartmouth Scholarship

Candida albicans biofilm formation is a key virulence trait that involves hyphal growth and adhesin expression. Pyocyanin (PYO), a phenazine secreted by Pseudomonas aeruginosa, inhibits both C. albicans biofilm formation and development of wrinkled colonies. Using a genetic screen, we identified two mutants, ssn3Δ/Δ and ssn8Δ/Δ, which continued to wrinkle in the presence of PYO. Ssn8 is a cyclin-like protein and Ssn3 is similar to cyclin-dependent kinases; both proteins are part of the heterotetrameric Cdk8 module that forms a complex with the transcriptional co-regulator, Mediator. Ssn3 kinase activity was also required for PYO sensitivity as a kinase dead mutant maintained …

Analysis Of Differential Mrna And Mirna Expression In An Alzheimer’S Disease Mouse Model, Amanda Hazy, Matthew Dalton

Other Undergraduate Scholarship

Research has shown that changes in gene expression play a critical role in the development of Alzheimer’s Disease (AD). Our project will evaluate genome-wide RNA expression patterns from brain and blood in an AD mouse model. This analysis will provide insight regarding the mechanisms of AD pathology as well as determine a possible diagnostic tool utilizing RNA expression patterns found in the blood as biomarkers for AD.

Hiv-1 Infection Of Macrophages Induces Retention Of Cholesterol Transporter Abca1 In The Endoplasmic Reticulum, Beda Brichacek, Christina Darwish, Anastas Popratiloff, Larisa Dubrovsky, Michael I. Bukrinsky

Microbiology, Immunology, and Tropical Medicine Faculty Publications

No abstract provided.

Malignant Hyperthermia, Chase Contri

Nursing Student Class Projects (Formerly MSN)

Although very rare, occurring one out of every 100,000 anesthesia cases, malignant hyperthermia is a hypermetabolic disorder that anesthesia providers screen and interrogate patients prior to every case they are administering anesthesia. Many research studies about anesthesia induced malignant hyperthermia have explored new methods of testing for the genetic susceptibility for malignant hyperthermia and into hospital based protocols when a patient starts to show the signs and symptoms of the metabolic disorder. This new knowledge and understanding has decreased patient mortality of anesthesia induced malignant hyperthermia from eighty percent to five percent over the past three decades (Rosenberg et al, …

Malignant Hyperthermia, Devin Poncsak

Nursing Student Class Projects (Formerly MSN)

A crisis of malignant hyperthermia is a medical emergency, and must be treated immediately with a coordinated, multidisciplinary team response in order to give the patient the highest chance for a successful recovery (Dirksen, Van Wicklin, Mashman, Neiderer, & Merritt, 2013). Malignant hyperthermia is defined by Bandschapp & Girard (2012), as “a disturbance of the skeletal muscle calcium homeostasis, triggered by volatile anaesthetics and depolarizing muscle relaxants.” Once a vulnerable patient is exposed to one of these triggering agents, a pathologic hypermetabolic response ensues, and the patient has a rapid increase in oxygen consumption and expired carbon dioxide, hyperthermia, acidosis, …

Acute Respiratory Distress Syndrome, Brian Flowers

Nursing Student Class Projects (Formerly MSN)

In healthcare, there are many interesting and intriguing conditions that are vital to understand from both a clinical and a pathophysiological standpoint. Comprehending and knowing how to treat these conditions effectively, ultimately leads to the best care and patient outcomes. As a current critical care nurse and future advanced practice nurse, it was important to select a research topic of interest to explore that would benefit a high risk group of patients. Based on this precedent, acute respiratory distress syndrome (ARDS) was chosen. As a critical care nurse, exposure to respiratory conditions and mechanical ventilation management is something nurses are …

Management Of A Dka Patient With Severe Metabolic And Ketoacidosis With Chronic Renal Insufficiency, Brian Albany

Nursing Student Class Projects (Formerly MSN)

Diabetic ketoacidosis (DKA) serves as one the leading causes of mortality in diabetic patients [14]. The mortality has decreased over the past several decades due to the rapid recognition of the disease state and the improvement of management of DKA [14]. Despite a decline in mortality rates over the past twenty years from 7.96% to 0.67%, errors in management of the disease state are associated with significant morbidity and mortality [2]. Utilization of DKA protocols in the acute care setting have allowed congruency in care and delivery of effective lifesaving treatment. Despite advances in standardized DKA protocols, there still remains …

The Pathophysiology Of Tumor Lysis Syndrome In Oncology Patients, Jessica Richardson

Nursing Student Class Projects (Formerly MSN)

Patients with oncological conditions are at an increased risk of developing a wide variety of complications from chemotherapy that they would not otherwise be exposed too. One such life threatening complication is tumor lysis syndrome, which is an oncology emergency that frequently lands patients in the intensive care unit. Tumor lysis syndrome (TLS) occurs most frequently after the initiation of chemotherapy or other chemotoxic drugs during the patients’ treatment course [8]. It causes faster than normal tumor cell breakdown and release of intracellular contents into the general circulation. [8]. This leads to a very predictable development of electrolyte imbalances to …

Multimodal Therapy For Postoperative Pain Management, Karen Lynch

Nursing Student Class Projects (Formerly MSN)

Multimodal therapy works best to control postoperative pain safely. Multimodal pain treatment involves the use of two or more classes of analgesics to target different pain mechanisms. Why? Data is present that supports that health care systems are still under treating pain in the postoperative patient. Unrelieved pain has harmful effects to multi ple body systems. There is still a need to provide education to providers, nurses and patients to promote best practice in pain management approaches regarding multimodal therapy. Opiate analgesics still remain the most commonly used treatment for pain following surgery. Using this singular analgesic modality could put …

Necrotizing Fasciitis, Holly Herron

Nursing Student Class Projects (Formerly MSN)

Necrotizing fasciitis also known as necrotizing soft tissue infections (NSTIs) is a rare life-threatening infection that involves the skin and soft tissue. A rapid and accurate diagnosis of NSTIs must be identified by healthcare providers to diminish morbidity and mortality. NSTIs are characterized by progressive necrosis of subcutaneous tissue and fascia involving large areas of tissue (Lin, Chang, Lai, Lin, & Chen, 2013). Hippocrates (500 BC) described necrotizing fasciitis as “diffuse erysipelas caused by trivial accidents [where] flesh, sinews, and bones fell away in large quantities, [leading to] death in many cases” (Lancerotto, Tocco, Salmaso, Vindigni & Bassetto, 2012). In …

Necrotizing Fasciitis: The “Flesh Eating” Disease, John Neukam

Nursing Student Class Projects (Formerly MSN)

Necrotizing fasciitis, often referred to as the “flesh-eating disease”, is a rare bacterial infection with an extremely high mortality rate with symptoms that begin subtle but can quickly ravish the human body.1 While the prevalence of this disease is relatively low, evidence of this disease can be traced back as far as the 5th century BC where it was initially described by Hippocrates.2 It wasn’t until 1952 however that Dr. Bob Wilson termed the disease “necrotizing fasciitis”.3 The rapid progression of this disease and the acute deterioration it causes in a patient is extremely intriguing. This “flesh-eating disease” can present …

Accurate Intervention In Visceral Aneurysms, Megan Hoying

Nursing Student Class Projects (Formerly MSN)

A 30 year old male presented to the ED with a one week history of fever, abdominal pain, and poor PO intake due to nausea and emesis. He was given a GI cocktail and sent home for a presumed diagnosis of gastritis. After having persistent pain the patient returned to the ER the following day and was admitted for further testing. The patient died 3 days later. This is an interesting case presentation, and was in no way straightforward.

Pseudocholinesterase Deficiency, Ross Gerken

Nursing Student Class Projects (Formerly MSN)

Pseudocholinesterase deficiency is a rare genetic or acquired variation in the metabolism of choline esters such as the neuromuscular blockers succinylcholine, mivacurium, and ester local anesthetics. Pseudocholinesterase deficiency genetically is transmitted in an autosomal recessive pattern with the frequency of apnea from a genetic abnormality of pseudocholinesterase between 1:480 and 1:3200 people (Ok et al., 2013). An extended period of neuromuscular blockade results from these medications than what is clinically expected. The signs and symptoms which occur are apnea and paralysis hours longer. This condition is rare but must be known and understood by the clinician in order to provide …

Understanding The Mystery Of Brain Death, Natalie A. Felter

Nursing Student Class Projects (Formerly MSN)

Lack of understanding of brain death has contributed to recent controversial cases (Copnell, 2014). The cases of Jahi McMath and Marlise Munoz were the focus of national news, causing an intense debate among the public and healthcare professionals (Copnell, 2014). The concept of brain death is a mystery to the public (Powell, 2014). Copnell (2014) found that 60% of family members who had been told their loved one was brain dead believed that they were still alive. Health professionals not having a clear grasp of brain death’s definition and assessment can lead to increased confusion in family members (Powell, 2014).

Hypertrophic Obstructive Cardiomyopathy, Tiffany Branson

Nursing Student Class Projects (Formerly MSN)

Hypertrophic obstructive cardiomyopathy or HOCM, is a genetic disease that is described as hypertrophy or enlargement of the left ventricle which obstructs the blood flow to the body (Yue-Cheng et al., 2012). HOCM is a disease that cannot be cure, but can be treated. One of the main goals of treatment is to focus on treating the symptoms. HOCM can be asymptomatic or symptomatic and can cause some major complications. Some of the complications of HOCM are arrhythmias and sudden cardiac death, “which is defined as natural death to due cardiac causes, heralded by abrupt loss of consciousness within one …

Dvt And Economy Class Syndrome, Troy Perkins

Nursing Student Class Projects (Formerly MSN)

Traveling long distances can be very stressful on the body. Deep vein thrombosis (DVT) has often been linked to long air flights or long distance travel in a vehicle. DVT is a blood clot usually formed in the legs. Economy Class Syndrome (ECS) has been referred to as the formation of a DVT occurring during (or just after) a long airplane flight, especially in economy class where there is the least space allotted per passenger and one’s legs especially tend to be immobilized for lack of leg room (MedicineNet, 2012). Developing a DVT can lead to other life-threatening illnesses such …

Does Your Child Have Reflux Or Could There Be More To It Than That, Cody Elam

Nursing Student Class Projects (Formerly MSN)

Eosinophilic esophagitis (EE) is differentiated from Gastroesophageal Reflux Disease (GERD) by endoscopic and histopathologic examination. The hallmark of EE is eosinophilic infiltration of the esophagus. EE has been defined as “a clinicopathologic entity, combining clinical data on (1) relevant symptoms (distinct in the pediatric or adult populations with mostly food impaction and dysphagia in adults and feeding intolerance, failure to thrive, and GERD symptoms in children); (2) esophageal biopsies with adequate histologic findings in the esophageal biopsies (>15 eosinophils/high power field [HPF]); and (3) exclusion of other diseases with overlapping features, especially GERD” (Genevay, Rubbia-Brandt, & Rougemont, 2010, p.816). …