Medicine and Health Sciences Commons^™

Neuropsychiatric Effects Of Tenofovir In Comparison With Other Antiretroviral Drugs., Kathleen Ferrer, Natella Rakhmanina

Pediatrics Faculty Publications

Tenofovir is a widely used antiretroviral medication indicated to treat adults and children infected with HIV. Current guidelines for the management of HIV infection recommend tenofovir disoproxil fumarate (TDF) as a component of the preferred first-line combination antiretroviral therapy. The efficacy, tolerability, prolonged half-life allowing for once-daily administration, and availability as a component of several fixed-dose formulations make TDF an attractive choice for treatment-naive and treatment-experienced HIV-infected patients. TDF is also widely used as a component of postexposure prophylaxis in noninfected individuals. Most importantly, it has been recently approved for use as pre-exposure prophylaxis for noninfected adults and adolescents to …

Can Changes In Angiogenic Biomarkers Between The First And Second Trimesters Of Pregnancy Predict Development Of Pre-Eclampsia In A Low-Risk Nulliparous Patient Population?, Leslie Myatt, Rebecca G. Clifton, J. M. Roberts, Catherine Y. Spong, Ronald J. Wapner, +10 Additional Authors

GW Biostatistics Center

OBJECTIVE:

To determine if change in maternal angiogenic biomarkers between the first and second trimesters predicts pre-eclampsia in low-risk nulliparous women.

DESIGN:

A nested case-control study of change in maternal plasma soluble Flt-1 (sFlt-1), soluble endoglin (sEng) and placenta growth factor (PlGF). We studied 158 pregnancies complicated by pre-eclampsia and 468 normotensive nonproteinuric controls.

SETTING:

A multicentre study in 16 academic medical centres in the USA.

POPULATION:

Low-risk nulliparous women.

METHODS:

Luminex assays for PlGF, sFlt-1 and sEng performed on maternal EDTA plasma collected at 9-12, 15-18 and 23-26 weeks of gestation. Rate of change of analyte between first and …

Family Caregivers: The Primary Providers Of Assistance To People With Functional Limitations And Chronic Impairments, Carol O'Shaughnessy

National Health Policy Forum

An extensive body of research conducted over the past several decades has documented that family or other unpaid caregivers provide the majority of care to people who need assistance because of functional limitations or multiple and complex chronic conditions. Families play a central role not only in assisting impaired family members with personal care needs, but also in helping them coordinate health care and supportive services, and, increasingly, providing and/or supervising home-based medical care. This paper presents background information on family caregiving, briefly describes federal programs that provide direct assistance to caregivers, and discusses possible future policy and practice directions.

The Community Living Assistance Services And Supports (Class) Act: Major Legislative Provisions, Carol O'Shaughnessy

National Health Policy Forum

Update (January 3, 2013) — In 2010, Congress enacted the Community Living Assistance Services and Supports (CLASS) Act as part of the Patient Protection and Affordable Care Act (P.L. 111-148). The CLASS Act was repealed as part of the American Taxpayer Relief Act of 2012 signed by the President on January 2, 2013.

During 2011 the Department of Health and Human Services (HHS) conducted an analysis of possible CLASS implementation options consistent with the statutory requirements that the program be actuarially solvent over a 75-year period and self-funded. After a 19-month period of analysis, HHS officials stated in testimony before …

Prevalence Of Antibiotic-Resistant E. Coli In Retail Chicken: Comparing Conventional, Organic, Kosher, And Raised Without Antibiotics, Jack M. Millman, Kara Waits, Heidi Grande, Ann R. Marks, Jane C. Marks, Lance B. Price, Bruce A. Hungate

Environmental and Occupational Health Faculty Publications

Retail poultry products are known sources of antibiotic-resistant Escherichia coli, a major human health concern. Consumers have a range of choices for poultry, including conventional, organic, kosher, and raised without antibiotics (RWA) – designations that are perceived to indicate differences in quality and safety. However, whether these categories vary in the frequency of contamination with antibiotic-resistant E. coli is unknown. We examined the occurrence of antibiotic-resistant E. coli on raw chicken marketed as conventional, organic, kosher and RWA. From April – June 2012, we purchased 213 samples of raw chicken from 15 locations in the New York City metropolitan …

Neuroimaging Of A Pilocytic Astrocytoma With Anaplastic Features And Diffusion Tensor Imaging Characteristics, Lara Walkoff, Andrew J. Degnan, Mark Ghassibi, Robert V. Jones, Jonathan H. Sherman, Lucien M. Levy

Radiology Faculty Publications

We report the magnetic resonance imaging findings of an adult patient with a biopsy-proven pilocytic astrocytoma with anaplastic features. Pilocytic astrocytomas rarely occur in adults, and presentation with anaplastic features such as rapid mitotic activity, hypercellularity, and atypia is particularly uncommon. Accurate neuroimaging diagnosis is essential, but differentiation from more malignant neoplastic lesions may be challenging. Diffusion tensor imaging may potentially provide information on cell proliferation, vascularity, and fiber destruction, which can have implications for treatment and prognosis. In this case, tractography and fractional anisotropy maps demonstrated displacement of adjacent parenchyma and relatively intact fractional anisotropy, which is more suggestive …

Narcotics In Rheumatology, Mahsa Tehrani, Mathia Aguiar, James D. Katz

Global Health Faculty Publications

Patients with rheumatic conditions often suffer from related chronic pain. When first-line traditional medications such as acetaminophen and anti-inflammatory medications do not suffice, then other options are needed. The traditional medications may ultimately not provide sufficient pain relief, or alternatively, they can pose as a contraindication due to underlying hypertension, renal, and/or hepatic disease. Therefore, narcotics are an alluring alternative, which if used in a multidisciplinary and systematic approach to the patient, can prove to be quite beneficial in the lives of these patients.

Modeling The Impact And Costs Of Semiannual Mass Drug Administration For Accelerated Elimination Of Lymphatic Filariasis, Wilma A. Stolk, Quirine A. Ten Bosch, Sake J. De Vlas, Peter U. Fischer, Gary J. Weil, Ann S. Goldman

Epidemiology Faculty Publications

The Global Program to Eliminate Lymphatic Filariasis (LF) has a target date of 2020. This program is progressing well in many countries. However, progress has been slow in some countries, and others have not yet started their mass drug administration (MDA) programs. Acceleration is needed. We studied how increasing MDA frequency from once to twice per year would affect program duration and costs by using computer simulation modeling and cost projections. We used the LYMFASIM simulation model to estimate how many annual or semiannual MDA rounds would be required to eliminate LF for Indian and West African scenarios with varied …

Environmental Exposure To Pyrethroids And Sperm Sex Chromosome Disomy: A Cross-Sectional Study, Heather A. Young, John D. Meeker, Sheena E. Martenies, Zaida I. Figueroa, Dana Boyd Barr, Melissa J. Perry

Epidemiology Faculty Publications

Background

The role of environmental pesticide exposures, such as pyrethroids, and their relationship to sperm abnormalities are not well understood. This study investigated whether environmental exposure to pyrethroids was associated with altered frequency of sperm sex chromosome disomy in adult men.

Methods

A sample of 75 subjects recruited through a Massachusetts infertility clinic provided urine and semen samples. Individual exposures were measured as urinary concentrations of three pyrethroid metabolites ((3-phenoxybenzoic acid (3PBA), cis- and trans- 3-(2,2-Dichlorovinyl)-1-methylcyclopropane-1,2-dicarboxylic acid (CDCCA and TDCCA)). Multiprobe fluorescence in situ hybridization for chromosomes X, Y, and 18 was used to determine XX, YY, XY, 1818, and …

Surgical Management Of Pediatric Gastroesophageal Reflux Disease, Hope T. Jackson, Timothy D. Kane

Surgery Faculty Publications

No abstract provided.

A New Gamboge Derivative Compound 2 Inhibits Cancer Stem-Like Cells Via Suppressing Egfr Tyrosine Phosphorylation In Head And Neck Squamous Cell Carcinoma, Rongxin Deng, Xu Wang, Yang Liu, Ming Yan, Sayaka Hanada, Qin Xu, Jianjun Zhang, Zeguang Han, Wentao Chen, Ping Zhang

Nursing Faculty Publications

Cancer stem-like cells represent a population of tumour-initiating cells that lead to the relapse and metastasis of cancer. Conventional anti-cancer therapeutic drugs are usually ineffective in eliminating the cancer stem-like cells. Therefore, new drugs or therapeutic methods effectively targeting cancer stem-like cells are in urgent need to successfully cure cancer. Gamboge is a natural anti-cancer medicine whose pharmacological effects are different from those of conventional chemotherapeutical drugs and they can kill some kinds of cancer cells selectively. In this study, we identified a new gamboge derivative, Compound 2 (C2), which presents eminent suppression effects on cancer cells. Interestingly, when compared …

Effects Of Treatment On Ige Responses Against Parasite Allergen-Like Proteins And Immunit To Reinfection In Childhood Schistosome And Hookworm Coinfections, Angela Pinot De Moira, Frances M. Jones, Shona Wilson, Edridah Tukahebwa, Colin M. Fitzsimmons, Joseph K. Mwatha, Jeffrey M. Bethony, Narcis B. Kabatereine, David W. Dunne

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Naturally occurring human immunity to both schistosomiasis and hookworm infection has been associated with IgE responses against parasite allergen-like proteins. Since the two helminths frequently coinfect the same individuals, there is growing advocacy for their concurrent treatment. However, both helminths are known to exert strong immunomodulatory effects; therefore, coinfected individuals could have immune responses different from those characteristically seen in monoinfected individuals. In this study, we measured changes in IgE, IgG1, and IgG4 responses to schistosome and hookworm antigens, including the allergen-like proteins Schistosoma mansoni tegumental-allergen-like 1 protein (SmTAL1), SmTAL2, and Necator americanus Ancylostoma-secreted protein-2 (Na-ASP-2), following concurrent …

Htlv Tax: A Fascinating Multifunctional Co-Regulator Of Viral And Cellular Pathways, Robert Currer, Rachel Van Duyne, Elizabeth Jaworski, Irene Guendel, Gavin Sampey, Ravi Das, Aarthi Narayanan, Fatah Kashanchi

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Human T-cell lymphotropic virus type 1 (HTLV-1) has been identified as the causative agent of adult T-cell leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The virus infects between 15 and 20 million people worldwide of which approximately 2–5% develop ATL. The past 35 years of research have yielded significant insight into the pathogenesis of HTLV-1, including the molecular characterization of Tax, the viral transactivator, and oncoprotein. In spite of these efforts, the mechanisms of oncogenesis of this pleiotropic protein remain to be fully elucidated. In this review, we illustrate the multiple oncogenic roles of Tax by summarizing a recent …

Transcriptional Responses Of In Vivo Praziquantel Exposure In Schistosomes Identifies A Functional Role For Calcium Signalling Pathway Member Camkii, Hong You, Donald P. Mcmanus, Wei Hu, Michael J. Smout, Paul J. Brindley, Geoffrey N. Gobert

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Treatment for clinical schistosomiasis has relied centrally on the broad spectrum anthelmintic praziquantel; however, there is limited information on its mode of action or the molecular response of the parasite. This paper presents a transcriptional and functional approach to defining the molecular responses of schistosomes to praziquantel. Differential gene expression in Schistosoma japonicum was investigated by transcriptome-wide microarray analysis of adult worms perfused from infected mice after 0.5 to 24 hours after oral administration of sub-lethal doses of praziquantel. Genes up-regulated initially in male parasites were associated with “Tegument/Muscle Repair” and “Lipid/Ion Regulation” functions and were followed by “Drug Resistance” …

Thrombospondin-1 Signaling Through Cd47 Inhibits Self-Renewal By Regulating C-Myc And Other Stem Cell Transcription Factors, Sukhbir Kaur, David R. Soto-Pantoja, Erica V. Stein, Chengyu Liu, Abdel G. Elkahloun, Michael L. Pendrak, Alina Nicolae, Satya P. Singh, Zuqin Nie, David Levens, Jeffrey S. Isenberg, David D. Roberts

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Signaling through the thrombospondin-1 receptor CD47 broadly limits cell and tissue survival of stress, but the molecular mechanisms are incompletely understood. We now show that loss of CD47 permits sustained proliferation of primary murine endothelial cells, increases asymmetric division, and enables these cells to spontaneously reprogram to form multipotent embryoid body-like clusters. c-Myc, Klf4, Oct4, and Sox2 expression is elevated in CD47-null endothelial cells, in several tissues of CD47- and thrombospondin-1-null mice, and in a human T cell line lacking CD47. CD47 knockdown acutely increases mRNA levels of c-Myc and other stem cell transcription factors in cells and in vivo, …

Cd56negcd16+ Nk Cells Are Activated Mature Nk Cells With Impaired Effector Function During Hiv-1 Infection, Jeffrey M. Milush, Sandra López-Vergès, Vanessa A. York, Steven G. Deeks, Jeffrey N. Martin, Frederick M. Hecht, Lewis L. Lanier, Douglas F. Nixon

Microbiology, Immunology, and Tropical Medicine Faculty Publications

BACKGROUND: A subset of CD3(neg)CD56(neg)CD16⁺ Natural Killer (NK) cells is highly expanded during chronic HIV-1 infection. The role of this subset in HIV-1 pathogenesis remains unclear. The lack of NK cell lineage-specific markers has complicated the study of minor NK cell subpopulations.

RESULTS: Using CD7 as an additional NK cell marker, we found that CD3(neg)CD56(neg)CD16⁺ cells are a heterogeneous population comprised of CD7⁺ NK cells and CD7(neg) non-classical myeloid cells. CD7⁺CD56(neg)CD16⁺ NK cells are significantly expanded in HIV-1 infection. CD7⁺CD56(neg)CD16⁺ NK cells are mature and express KIRs, the C-type lectin-like receptors NKG2A and NKG2C, and natural cytotoxicity receptors similar to …

Few U.S. Public Health Schools Offer Courses On Palliative And End-Of-Life Care Policy, Dale Lupu, Caroline Deneszczuk, Tara Leystra, Rebecca Mckinnon, Victoria Seng

Physical Therapy and Health Care Sciences Faculty Publications

Background: Palliative care has been identified by the World Health Organization (WHO) as a critical policy element for the relief of suffering, yet palliative care policy receives minimal attention in mainstream U.S. public health journals, conferences, or textbooks. In the ’90s, documentation of the lack of attention to end-of-life and palliative care in medical and nursing curricula led to concerted efforts to improve medical and nursing education in palliative care. No such educational effort has yet been directed toward public health professionals.

Objective: This study's objective was to quantify current course offerings covering palliative and end-of-life care from a public …

False Passage To The Trachea After Emergency Intubation In A Victim Of Near Hanging, Ali Pourmand, Hamid A. Shokoohi

Emergency Medicine Faculty Publications

Emergency medicine physicians should have enough knowledge and experience to deal with emergent and traumatic difficult airway. In this paper, we present a case of near hanging with neck soft tissue injury, tracheal and esophageal rupture that is complicated by a displaced intubation and false passage to the trachea.

Tension Pneumothorax, Pneumoperitoneum, And Cervical Emphysema Following A Diagnostic Colonoscopy, Ali Pourmand, Hamid A. Shokoohi

Emergency Medicine Faculty Publications

Colonoscopy is currently a widespread procedure used in screening for colorectal cancer. Iatrogenic colonic perforation during colonoscopy is a serious and potentially life-threatening complication that can cause significant morbidity and mortality. “Triple pneumo” (a combination of pneumothorax, pneumomediastinum, and pneumoperitoneum) following colonoscopy is a rare but a serious condition requiring immediate diagnosis and emergent intervention. In majority of these cases a colonic perforation is the initial injury that is followed by pneumothorax and pneumomediastinum through the potential anatomical connection with retroperitoneal and mediastinal spaces. In this rare case report we are presenting a case of “triple pneumo” with no evidence …

Impacts Of Social Networking Sites On Patient Care In The Emergency Department, Anne Bennett, Ali Pourmand, Robert Shesser, Jesus Sanchez, Joseph Joyce

Emergency Medicine Faculty Publications

The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a “hot topic” in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her …

A Syndromic Approach To Emergency Department Surveillance For Skin And Soft Tissue Infections, Larissa S. May, Marcus Rennick, Leah Gustafson, Julia Gunn

Emergency Medicine Faculty Publications

Objective

We sought to describe the epidemiology of emergency department (ED) visits for skin and soft tissue infections (SSTI) in an urban area with diverse neighborhood populations using syndromic surveillance system data for the time period from 2007–2011. Our aims were threefold: to demonstrate a proof of concept using syndromic surveillance for SSTI surveillance in the absence of laboratory data, to estimate the burden of ED visits associated with SSTI, and to determine potential geographic “hotspots” for these infections.

Introduction

The incidence of and hospitalizations for SSTI have steadily increased over the last decade in the United States, primarily due …

Smoking Experimentation Among Elementary School Students In China: Influences From Peers, Families, And The School Environment, Cheng Huang, Jeffrey Koplan, Shaohua Yu, Changwei Li, Chaoran Guo, Jing Liu, Hui Li, Michelle Kegler, Pam Redmon, Michael Eriksen

Global Health Faculty Publications

The aim of this study was to investigate experimentation with smoking among primary school students in China. Data were acquired from a recent survey of 4,073 students in grades 4 to 6 (ages 9–12) in 11 primary schools of Ningbo City. The questions were adapted from the Global Youth Tobacco Survey (GYTS). Results suggest that although the Chinese Ministry of Education (MOE) encourages smoke-free schools, experimentation with cigarettes remains a serious problem among primary school students in China. Peers, family members, and the school environment play important roles in influencing smoking experimentation among students. Having a friend who smoked, seeing …

Web-Scale Discovery In An Academic Health Sciences Library: Development And Implementation Of The Ebsco Discovery Service, Jolinda Thompson, Kathe Obrig, Laura E. Abate

Himmelfarb Library Faculty Publications

No abstract provided.

Strengthening Our Collaborations: Building An Electronic Health Record Educational Module, Alexandra Gomes, Anne Linton, Laura E. Abate

Himmelfarb Library Faculty Publications

No abstract provided.

The Dn2 Myeloid-T (Dn2mt) Progenitor Is A Target Cell For Leukemic Transformation By The Tlx1 Oncogene, Lynnsey A. Zweier-Renn, Irene Riz, Teresa S. Hawley, Robert G. Hawley

Anatomy and Regenerative Biology Faculty Publications

Introduction: Inappropriate activation of the TLX1 (T-cell leukemia homeobox 1) gene by chromosomal translocation is a recurrent event in human T-cell Acute Lymphoblastic Leukemia (T-ALL). Ectopic expression of TLX1 in murine bone marrow progenitor cells using a conventional retroviral vector efficiently yields immortalized cell lines and induces T-ALL-like tumors in mice after long latency.

Methods: To eliminate a potential contribution of retroviral insertional mutagenesis to TLX1 immortalizing and transforming function, we incorporated the TLX1 gene into an insulated self-inactivating retroviral vector.

Results: Retrovirally transduced TLX1-expressing murine bone marrow progenitor cells had a growth/survival advantage and readily gave rise to immortalized …

Cuentos - 2013, George Washington University, Medical Faculty Associates

Cuentos

Cuentos is the humanities magazine of the George Washington University Medical Faculty Associates Department of Internal Medicine.

State Foodborne Illness Surveillance And Response Laws: Compilation And Analysis, Stephanie David, Jenna Burton, Chris Chadwick, Rebecca Katz

Health Policy and Management Faculty Publications

Objective

To document and assess the variation in state legislation relating to foodborne disease surveillance and outbreak response for all 50 states and the District of Columbia by creating a database and appendix of laws and regulations that will be made available to researchers and policymakers.

Introduction

Foodborne illnesses sicken 48 million and kill 3,000 Americans every year, presenting an enduring threat to the public’s health. In just the past three years alone, the United States has experienced at least four major multistate outbreaks in food. Despite this growing problem, efforts to prevent foodborne illness pose a particular public health …

Dysembryoplastic Neuroepithelial Tumor With Atypical Presentation: Mri And Diffusion Tensorcharacteristics, Kalyan Paudel, Samuel Borofsky, Robert V. Jones, Lucien M. Levy

Radiology Faculty Publications

We report the neuroimaging findings of a 26-year-old female patient with a biopsy-proven dysembryoplastic neuroepithelial tumor (DNET). DNETs are an uncommon, usually benign, glial-neural cortical neoplasm of children and young adults who typically present with intractable seizures. DNETs may occur in any region of the supratentorial cortex, but have a predilection for the temporal lobes. Accurate neuroimaging diagnosis is essential since patients with DNET benefit from complete resection. However, accurate differentiation from other cortical lesions may be challenging. Typical conventional Magnetic Resonance Imaging (MRI) features can help in the differentiation from other similar cortical tumors. Diffusion tensor imaging can also …

Unclamped Hand-Assisted Laparoscopic Partial Nephrectomy For Predominantly Endophytic Renal Tumors, Jason D. Engel, Stephen B. Williams

Urology Faculty Publications

PURPOSE: To describe our initial experience with unclamped laparoscopic hand-assisted partial nephrectomy for predominantly endophytic renal masses in the setting of relative contraindication to warm ischemia.

MATERIALS AND METHODS: Unclamped laparoscopic hand-assisted partial nephrectomy was performed on eight consecutive patients from June 2009 to March 2010. All patients had predominantly endophytic renal masses with a preferential enhancing rim noted on the pre-operative computed tomography. The unclamped hand-assisted approach was utilized for no warm ischemia, minimal blood loss, and enhanced visualization of the tumor bed with improved operative exposure.

RESULTS: Mean age of the participants was 55.8 years. All patients underwent …

Wound Care Challenges In Children And Adults With Spina Bifida: An Open-Cohort Study, Katherine Ottolini, Amy B. Harris, June K. Amling, Ann M. Kennelly, Leslie A. Phillips, Laura L. Tosi

Pediatrics Faculty Publications

Skin breakdown is a frequent concern for individuals with spina bifida. We explored wound incidence in patients with spina bifida and how it varies across a person's life span and functional neurologic level. We examined the settings in which skin breakdown most commonly occurred, looking for evidence of chronic, non-healing wounds. We also sought to develop criteria to improve wound monitoring. We identified reported wound episodes in an open-cohort study over a 13-year period, examining the hospital and outpatient clinical records of spina bifida patients at Children's National Medical Center (CNMC). Current age, age at wound presentation, sex, weight, functional …