Medicine and Health Sciences Commons^™

Diagnostic Error - Mini Review And Case Report Of Patient Death Resulting From Delayed Diagnosis Of Acute Prostatitis, Dragica K. Mrkoci, Katherine C. Chretien

Medicine Faculty Publications

A 57-year old man presenting with frequent and painful urination and negative initial urinalysis for infection was given a diagnosis of benign prostate hypertrophy, which was never revised by subsequent providers. Instead, the patient continued to be treated for urinary retention and pain. A potent NSAID, Toradol (ketorolac), was included in his regimen. One day prior to his demise, the patient was diagnosed with prostatic abscess and admitted for treatment with intravenous antibiotics. However the patient died on hospital day one from massive GI bleeding. Autopsy revealed an underlying peptic ulcer.

This case shines a light on diagnostic error: missed, …

No-Pharmacological Intervention: Pomegranate Juice For The Management Of Hypertension And The Improvement Of Cardiovascular Health, Konstantinos Tzimalos, Michael N. Doumas, Vasilios Athyros

Medicine Faculty Publications

No abstract provided.

The Emergence Of Ambulatory Measurement Of Arterial Stiffness And Central Blood Pressure: A Promising Novelty Of Clinical Importance Or Just Another Marker?, Antonios Lazaridis, Aristotle University Of Thessaloniki, Michael N. Doumas, Andromachi Reklou, A. Karagiannis

Medicine Faculty Publications

Whereas brachial blood pressure (BP) is still considered the gold standard for the estimation of cardiovascular risk in all clinical trials and guidelines, scientific interest is shifting towards central hemodynamics and the scientific community is experiencing a whole new revolution with the emergence of novel cardiovascular markers such as the ambulatory measurement of central BP and arterial stiffness. Central BP has already started to demonstrate its superiority over peripheral BP as a better and more reliable predictor of end-organ damage in cardiovascular diseases. Furthermore, ambulatory measurement of central BP and pulse wave velocity are expected to add much more useful …

Foreign Body Aspiration Presenting With Asthma-Like Symptoms, Jennifer C. Kam, Vikram Doriswamy, Javier F. Dieguez, Joan Dabu, Matthew Cholankeril, Mayur Govind, Richard Miller, Marc Adelman

Medicine Faculty Publications

Aspiration of a foreign body into the tracheobronchial tree is rare in adults. In the majority of these cases there is an underlying condition such as mental retardation, depressed mental status, impairment in the swallowing reflex, neurological impairment, alcohol or sedative abuse, or complications from dental manipulations that contributed to the aspiration. These patients are commonly misdiagnosed with asthma and typically do not respond to mainstay anti-inflammatory and/or bronchodilator therapy. We describe the case of a patient with a foreign body aspiration in the upper trachea not recognized by radiographic studies that presented with asthma-type symptoms.

Genomic Profiling Reveals The Potential Role Of Tcl1a And Mdr1 Deficiency In Chemotherapy-Induced Cardiotoxicity, Timothy A. Mccaffrey, Constantine Tziros, Jannet Lewis, Richard Katz, Robert S. Siegel, William B. Weglicki, Jay H. Kramer, I. Tong Mak, Ian Toma, Liang Chen, Elizabeth Benas, Alexander Lowitt, Shruti Rao, Linda Witkin, Yi Lian, Zhaoqing Yang, Sidney W. Fu

Medicine Faculty Publications

Background: Anthracyclines, such as doxorubicin (Adriamycin), are highly effective chemotherapeutic agents, but are well known to cause myocardial dysfunction and life-threatening congestive heart failure (CHF) in some patients.

Methods: To generate new hypotheses about its etiology, genome-wide transcript analysis was performed on whole blood RNA from women that received doxorubicin-based chemotherapy and either did, or did not develop CHF, as defined by ejection fractions (EF)≤40%. Women with non-ischemic cardiomyopathy unrelated to chemotherapy were compared to breast cancer patients prior to chemo with normal EF to identify heart failure-related transcripts in women not receiving chemotherapy. Byproducts of oxidative stress in plasma …

Biclonal Gammopathy In A Patient Taking Efalizumab For The Treatment Of Psoriasis, Antonia Fthenakis, Kurt S. Wenk, Alison Ehrlich, Jeanny B. Aragon-Ching

Dermatology Faculty Publications

We report a patient who developed biclonal gammopathy of undetermined significance during treatment with
efalizumab for psoriasis. This plasma cell disorder was found during the evaluation of the patient’s complaint of mild lower extremity paresthesia. The gammopathy spontaneously remitted following cessation of therapy and has not recurred to date. Given the increasing use and development of biological agents for the treatment of psoriasis and other disorders, this finding and the mechanisms by which it may have occurred is of clinical significance.

B Cell Acute Lymphoblastic Leukemia Associated With T(8;22)(P11.2q11.2): Role Of Additional Cytogenic Anomalies, Kate M. Serdy, Shireen R. Khoury, Louis Depalma

Pathology Faculty Publications

B lymphoblastic leukemia (B-ALL) may be associated with recurrent cytogenetic and molecular abnormalities. We describe the fourth-known case of B-ALL associated with the t(8;22)(p11.2q11.2) – a translocation seen more frequently in T lymphoblastic leukemia and acute myelogenous leukemia. This patient’s leukemia involves a combination of additional cytogenetic anomalies not yet described in the literature, including del(11)(q13q23), add(9)(p22), and monosomy 7. Given the role in B cell differentiation of genes in the affected regions, including MEN1 (11q13), ATM (11q22), ETS1(11q23), MLL (11q23), AF9 (9p22), and IKZ-F1 (7p12), this case may provide further insight into B cell leukemogenesis associated with the t(8;22). …

Whole Blood Platelet Aggregation And Release Reaction Testing In Uremic Patients, Jay Zeck, Jason Schallheim, Susie Q. Lew, Louis Depalma

Pathology Faculty Publications

Background: Platelet function analysis utilizing platelet-rich plasma and optical density based aggregometry fails to identify patients at risk for uremia associated complications.

Methods: We employed whole blood platelet aggregation analysis based on impedance as well as determination of ATP release from platelet granules detected by a chemiluminescence method. Ten chronic kidney disease (CKD) stage 4 or 5 predialysis patients underwent platelet evaluation. Our study aims to evaluate this platform in this patient population to determine if abnormalities could be detected. Results. Analysis revealed normal aggregation and ATP release to collagen, ADP, and high-dose ristocetin. ATP release had a low response …

Middle Ear Myoclonus: Two Informative Cases And A Systematic Discussion Of Myogenic Tinnitus, Aviva Ellenstein, Nadia Yusuf, Mark Hallett

Neurology Faculty Publications

Background: The term middle ear myoclonus (MEM) has been invoked to explain symptoms of tinnitus presumably caused by the dysfunctional movement of either of the two muscles that insert in the middle ear: tensor tympani and stapedius. MEM has been characterized through heterogeneous case reports in the otolaryngology literature, where clinical presentation is variable, phenomenology is scarcely described, the pathogenic muscle is usually not specified, natural history is unknown, and the presumptive definitive treatment, tensor tympani or stapedius tendon lysis, is inconsistently effective. It is not surprising that no unique acoustogenic mechanism or pathophysiologic process has been identified to explain …

Comparing Hormone Therapy Effects In Two Rcts And Two Large Observational Studies That Used Similar Methods For Comprehensive Data Collection And Outcome Assessment, Arthur Hartz, Tao He, Robert Wallace, John H. Powers

Medicine Faculty Publications

Objectives Prospective observational studies (OSs) that collect adequate information about confounders can validly assess treatment consequences. However, what constitutes adequate information is unknown. This study investigated whether the extensive information collected by the Women's Health Initiative (WHI) in two OSs and two randomised controlled trials (RCTs) was adequate.

Design Secondary analysis of WHI data. Cox regression was used to select from all baseline risk factors those that best predicted outcome. Cox regression that included these risk factors was used for two types of analyses: (1) comparing RCT and OS assessments of the effects of hormone therapy on outcome for participants …

Obesity And Preference-Weighted Quality Of Life Of Ethnically Diverse Middle School Children: The Healthy Study, Roberto P. Trevino, Trang H. Pham, Sharon Edelstein

GW Biostatistics Center

No abstract provided.

Himmelfarb Library Annual Report 2013, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Annual Report

No abstract provided.

The Effect Of Antihypertensive Drugs On Arterial Stiffness And Central Hemodynamics: Not All Fingers Are Made The Same, Michael N. Doumas, Eugenia Gkaliagkousi, N. Katsiki, Andromachi Reklou, Antonios Lazaridis, Konstantinos Karagiannis

Medicine Faculty Publications

Arterial stiffness and central hemodynamics attract increasing scientific interest within the hypertensive community during the last decade. Accumulating evidence indicates that aortic stiffness is a strong and independent predictor of cardiovascular events and all-cause mortality in hypertensive patients, and its predictive value extends beyond traditional risk factors. The role of central hemodynamics and augmentation index (a marker of reflected waves), remains less established and requires further investigation. Several lines of evidence indicate that antihypertensive therapy results in significant reductions of pulse wave velocity and central hemodynamics. However, beta-blockers seem to be the only exception with significant within-class differences. Conventional beta-blockers, …

Transmission Potential Of Influenza A/H7n9, February To May 2013, China, Gerardo Chowell, Lone Simonsen, Sherry Towers, Mark A. Miller, Cecile G. Viboud

Epidemiology Faculty Publications

Background

On 31 March 2013, the first human infections with the novel influenza A/H7N9 virus were reported in Eastern China. The outbreak expanded rapidly in geographic scope and size, with a total of 132 laboratory-confirmed cases reported by 3 June 2013, in 10 Chinese provinces and Taiwan. The incidence of A/H7N9 cases has stalled in recent weeks, presumably as a consequence of live bird market closures in the most heavily affected areas. Here we compare the transmission potential of influenza A/H7N9 with that of other emerging pathogens and evaluate the impact of intervention measures in an effort to guide pandemic …

Alloreactivity-Based Medical Conditions, Stanislav Vukmanovic, Margaret G. Petroff, Anne M. Stevens, Daniel Rukavina

Pediatrics Faculty Publications

No abstract provided.

A Case–Control Study Of Incident Rheumatological Conditions Following Acute Gastroenteritis During Military Deployment, Kathryn Deyoung, Mark A. Riddle, Larissa S. May, Chad K. Porter

Epidemiology Faculty Publications

Objectives The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis.

Design This case–control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population.

Setting We analysed health records of personnel deployed to Iraq or Afghanistan, including …

Hiding In Plain Sight: Building Community Special Social Capital In Distance Education Graduate Programs, Brenda H. Sheingold, Joyce A. Hahn, Anne Hofmeyer

Nursing Faculty Publications

No abstract provided.

Mind The Gap: Fostering Scholarship-Into-Practice For Advanced Practice Nursing Students Through Embedded Librarianship, Brenda H. Sheingold, Thomas Harrod

Nursing Faculty Publications

In recent years, librarianship has been increasingly recognized as a critical component of inter-professional healthcare education. This manuscript describes how innovative coordination between libraries and university healthcare programs can remove the barriers to scholarship for graduate students who enroll in distance education (DE) programs. The authors examined the perceived impact of librarian embedment for DE nursing students graduating with master’s degrees from George Washington University in 2013. Librarians were embedded in the first course in which they were enrolled in 2010 to support the mastery of scientific research skills. Analysis indicated that students strongly agreed that contact with embedded librarians …

Complete Genome Sequence Of The Epidemic And Highly Virulent Ctx-M-15-Producing H30-Rx Subclone Of Escherichia Coli St131, Paal S. Andersen, Marc Stegger, Maliha Aziz, Tania L. Contente-Cuomo, Henry S. Gibbons, Paul Keim, Evgeni V. Sokurenko, James R. Johnson, Lance B. Price

Environmental and Occupational Health Faculty Publications

We report the complete genome sequence, including five complete plasmid sequences, of Escherichia coli ST131 isolate JJ1886. The isolate was obtained in 2007 in the United States from a patient with fatal urosepsis and belongs to the virulent, CTX-M-15-producing H30-Rx sublineage.

Androgen Receptor-Target Genes In African American Prostate Cancer Disparities, Bi-Dar Wang, Qi Yang, Kristin Ceniccola, Fernando Bianco, Ramez Andrawis, Thomas W. Jarrett, Harold A. Frazier, Steven R. Patierno, Norman H. Lee

Pharmacology and Physiology Faculty Publications

The incidence and mortality rates of prostate cancer (PCa) are higher in African American (AA) compared to Caucasian American (CA) men. To elucidate the molecular mechanisms underlying PCa disparities, we employed an integrative approach combining gene expression profiling and pathway and promoter analyses to investigate differential transcriptomes and deregulated signaling pathways in AA versus CA cancers. A comparison of AA and CA PCa specimens identified 1,188 differentially expressed genes. Interestingly, these transcriptional differences were overrepresented in signaling pathways that converged on the androgen receptor (AR), suggesting that the AR may be a unifying oncogenic theme in AA PCa. Gene promoter …

Himmelfarb Library Liaison Letter - January 2013, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Genomic Loss Of Tumor Suppressor Mirna-204 Promotes Cancer Cell Migration And Invasion By Activating Akt/Mtor/Rac1 Signaling And Actin Reorganization, Saadi J. Imam, Jason R. Plyler, Hima Bansal, Suresh Prajapati, Sanjay Bansal, Jennifer Rebeles, Jeffrey S. Dome, +12 Additional Authors

Pediatrics Faculty Publications

Increasing evidence suggests that chromosomal regions containing microRNAs are functionally important in cancers. Here, we show that genomic loci encoding miR-204 are frequently lost in multiple cancers, including ovarian cancers, pediatric renal tumors, and breast cancers. MiR-204 shows drastically reduced expression in several cancers and acts as a potent tumor suppressor, inhibiting tumor metastasis in vivo when systemically delivered. We demonstrated that miR-204 exerts its function by targeting genes involved in tumorigenesis including brain-derived neurotrophic factor (BDNF), a neurotrophin family member which is known to promote tumor angiogenesis and invasiveness. Analysis of primary tumors shows that increased expression …

Changes In Latitudes, Changes In Attitudes: Fqhcs And Community Clinics In A Reformed Health Care Market, Jessamyn Taylor

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 and the Supreme Court’s related decision have significantly shifted the health care landscape for safety net providers. Federally qualified health centers (FQHCs) are a mainstay of primary care for the uninsured and those with limited access to care. This paper focuses on the impact of health reform on FQHCs given the significant federal investment in them through grants, Medicaid, and Medicare reimbursement. Where noteworthy, the effect on non-FQHC community clinics is also discussed. The implications of Medicaid coverage expansions (or lack thereof in states that choose not to expand), Medicaid disproportionate …

Current Opinion On Nanotoxicology, Ali Pourmand, Mohammad Abdollahi

Emergency Medicine Faculty Publications

Nanotechnology is one of the premiere technologies available today, having expanded both as field of scientific study and in the public consciousness. Despite this growth, the drawbacks, limitations and potential safety hazards associated with the incorporation of nanotechnology into existing industries are still being learned. The noticeable point is that there is no enough data available yet to analyze global use of nanotechnology from a meta-perspective. Three challenges can be defined in light of nanotoxicology. One, materials that might prove to be significantly toxic must be identified. Two, a system for the categorization of NP materials must be codified and …

The Involvement Of Acidic Nucleoplasmic Dna-Binding Protein (And-1) In The Regulation Of Prereplicative Complex (Pre-Rc) Assembly In Human Cells, Yongming Li, Haijie Xiao, Christelle De Renty, Aimee Jaramillo-Lambert, Zhiyong Han, Melvin L. Depamphilis, Kristy J. Brown, Wenge Zhu

Pediatrics Faculty Publications

No abstract provided.

Post-Transfusion Purpura In An African-American Man Due To Human Platelet Antigen-5b Alloantibody: A Case Report, Filipa Lynce, Fang Yin, Kirsten Alcorn, Vera Malkovska

Pediatrics Faculty Publications

Introduction

Post-transfusion purpura is a rare immunohematological disorder characterized by severe thrombocytopenia following transfusion of blood components and induced by an alloantibody against a donor platelet antigen. It occurs primarily in women sensitized by pregnancy and is most commonly caused by anti-human platelet antigen-1a antibodies. Here, we describe what we believe to be the first documented case of an African-American man who developed post-transfusion purpura due to an anti-human platelet antigen-5b alloantibody after receiving multiple blood products.

Case presentation

A 68-year-old African-American man initially admitted with atrial flutter was started on anticoagulation treatment, which was complicated by severe hematemesis. On …

Molecular Characterization Of A Tetraspanin From The Human Liver Fluke, Opisthorchis Viverrini, Supawadee Piratae, Smarn Tesana, Malcolm K. Jones, Paul J. Brindley, Alex Loukas, Erica Lovas, Veerachai Eursitthichai, Banchob Sripa, Sirikanda Thanasuwan, Thewarach Laha

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Background

The human liver fluke, Opisthorchis viverrini, is designated as a group 1 carcinogen, and is the major risk factor for cholangiocarcinoma in endemic countries throughout Southeast Asia. Proteins in the excretory-secretory products and tegumental surface membranes of the fluke have been proposed to play pivotal roles in parasite survival in the host, and subsequent pathogenesis. These macromolecules are therefore valid targets for the development of vaccines and new drugs to control the infection. Tetraspanins (TSP) are prominent components of the tegument of blood flukes where they are essential for tegument formation, are directly exposed to the immune system, …

Pediatric Spasticity, Kavita Parikh, Olga Morozova, Melanie Anspacher, Neha Shah

Pediatrics Posters and Presentations

No abstract provided.

Pediatric Spasticity, Kavita Parikh, Olga Morozova, Melanie Anspacher, Neha Shah

E-Learning Modules

Children with special health care needs (CSHCN) are increasingly prevalent in US hospitals. The pediatric hospitalist is often the primary provider of inpatient care for these patients. However, exposure to this patient population during training varies from provider to provider. No published educational curricula are specific to the inpatient care of this population. The purpose of this project is to build a multi-modal educational curriculum for providers with the overall goal of improving inpatient care for this at-risk population.

This curriculum is primarily composed of a series of topic-specific learning modules. Asynchronous learning modules, utilized appropriately, can augment learning by …

Extreme Measures: Field Amputation On The Living And Dismemberment Of The Deceased To Extricate Individuals Entrapped In Collapsed Structures, Anthony Macintyre, Efraim B. Kramer, Bruno P. Petinaux, Trevor Glass, Charmaine M. Tate

Emergency Medicine Faculty Publications

No abstract provided.