Medicine and Health Sciences Commons^™

Pharmacist Consult Service In Geriatric Trauma Patients, Vanessa M. Gleason, Pharm D., Rohit A. Moghe, Pharm D., Msph, Cde, Doris Warner, Msn, Rn, Cen, Michael S. Weinstein, Md, Facs

Pharmacy Presentations, Posters, and Grand Rounds

Introduction

• Geriatric patients (> 65 years of age) have a 3-5% incremental increase in annual occurrence of trauma making it a top five leading cause of death in this population.

• The mortality rate ranges from 15-30%, which is 4-5 times higher than younger patients.

• In 2011, data from the Pennsylvania Trauma Systems Foundation (PTSF) demonstrated nearly 32% of injured patients statewide and nearly 50% of the trauma patients at Thomas Jefferson University Hospital (TJUH) were > 65 years.

• Most geriatric patients have comorbidities that are treated with many medications, which may predispose them for falls.

• Although …

Impact Of Preadmission Beta-Blocker Use On Cardiac Abnormalities And In-Hospital Mortality In Patients With Aneurysmal Subarachnoid Hemorrhage, Toshimasa Okabe, Md, Anushya Jeyabalan, Md, Benjamin E. Leiby, Phd, Fred Rincon, Md, Walter K. Kraft, Md

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Introduction:

Various cardiac abnormalities, including dysrhythmias, left ventricular (LV) dysfunction, and myocardial injury, are commonly seen after subarachnoid hemorrhage (SAH). In patients taking a beta-blocker (BB) chronically, the medication is generally discontinued after hospitalization due to the concern of compromising cerebral perfusion. We hypothesized that sudden BB discontinuation might inadvertently lead to an increased incidence of composite cardiac abnormalities and higher in-hospital mortality in patients presenting with nontraumatic SAH.

Does A Contraceptive Bridge Method Affect Rates Of Postpartum Iud Placement In A Resident Urban Clinic?, Agatha Berger, Md, Erica Hinz, Md, Katherine Lackritz, Md, Elisabeth Woodhams, Md, Msc

Department of Obstetrics and Gynecology Presentations and Grand Rounds

Background

• Short interval pregnancies are associated with poor neonatal outcomes.1
• The postpartum (PP) period is an ideal time for LARC prevention of short interval pregnancy.2
• 29% of patients at our clinic admitted not using contraception 4-6 months postpartum.3

“It’S Persuasion Disguised As Information” The Experiences And Adaptations Of Abortion Providers Practicing Under A New Law, Rebecca J. Mercier Md Mph, Mara Buchbinder, Phd, Amy Bryant,Md,Mph, Laura Britton,Rn, Bsn

Department of Obstetrics and Gynecology Presentations and Grand Rounds

Background

Abortion laws are proliferating in the United States. From 2011 to 2013, 30 states passed a total of 205 abortion restrictions.¹ Increasingly, these laws are focused on abortion providers. Such laws have been criticized by professional organizations including the American College of Obstetricians and Gynecologists,² but few studies have assessed the impact of these laws on abortion providers.

In 2011 North Carolina passed HB 854, the “Women’s Right To Know Act” (WRTK). Similar to laws in 26 other states, WRTK mandates a 24-hour waiting period after counseling before an abortion can be performed. Content of the counseling …

Teamstepps: Radiologic Sciences Students’ Perspective, Sandra Freed, Amanda Lafontaine, Daniel Roberts, Allison Urbaniak, Collleen Dempsey, Ms, Rt (R)

Department of Radiologic Sciences Faculty Papers

Introduction

Interprofessional education aims to improve the health care system by encouraging healthcare professionals to learn from, with and about each other.

Interprofessional education activities assist in breaking the barriers between the various disciplines in our healthcare system. Students and employees can benefit from interprofessional education and training.

Development Of Syringomyelia From Retained Bullet Fragment Following Spinal Cord Injury, Akinpelu Beckley, Md, Mba, Christina V. Oleson, Md, Christopher S. Formal, Md

Department of Rehabilitation Medicine Faculty Papers

Objective

To investigate potential complications of retained bullet fragments in the spinal canal following traumatic spinal cord injury (SCI).

Treatment Of Duodenal Variceal Hemorrhage With Endoscopic Band Ligation, Tripti R. Chopade, Md, Jesse M. Civan, Md, Jonathan M. Fenkel, Md, Ali A. Siddiqui, Md, Ashish R. Gandhe, Md, Dina L. Halegoua-De Marzio, Md

Division of Gastroenterology and Hepatology Faculty Papers

Introduction

• Duodenal varices (DV) are a rare but potentially serious complication of portal hypertension and carry a high risk of massive gastrointestinal bleeding.

• This is a report of successful treatment of a massive DV hemorrhage with endoscopic band ligation.

Enteral Nutrition Support For A Sarcopenia In End-Stage Liver Disease, Dina Halegoua-De Marzio, Md, She-Yan Wong, Md, Flavius Guglielmo, Md, Jonathan M. Fenkel, Md

Division of Gastroenterology and Hepatology Faculty Papers

Introduction

• Weight loss with muscle wasting, also known as sarcopenia, commonly occurs in patients with end-stage liver disease (ESLD).
• A robust association between sarcopenia and mortality in cirrhotic and post-liver transplant patients has been reported.
• This is a report of a patient with severe sarcopenia and ESLD who was provided enteral nutrition using a Dobhoff tube (DHT) pre-liver transplant resulting in successful bridging to transplant.

Listing Practices For Morbidly Obese Patients At Liver Transplant Centers In The United States, Dina Halegoua-De Marzio, Md, She-Yan Wong, Md, Jonathan M. Fenkel, Md, Cataldo Doria, Md, Phd, David A. Sass, Md

Division of Gastroenterology and Hepatology Faculty Papers

Introduction

• Obesity affects more than one third of Americans.
• Morbid obesity (body mass index (BMI) >35 kg/m2) has been associated with multiple co-morbidities and perioperative complications.
• The effect of morbid obesity on liver transplant outcomes has yielded mixed results.

Seeing Is Believing: Optical Computed Tomography (Oct) And Histologic Analysis To Define Pathophysiology Of “Very”, Very Late Stent Thrombosis Occurring More Than 7 Years After Drug Eluting Stent Implantation, Antony G. Kaliyadan, Md, Alec Vishnevsky, Md, Henry Siu, Md, David Fishman, Md, John Farber, Md, Nicholas Ruggiero Ii, Md, Michael P. Savage, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Case Presentation

• 58-year-old male with prior non-ST elevation MI with PCI performed using a sirolimus eluting stent placed in a large OM1 branch 86 months prior presented with five hours chest pain similar to prior MI >7 years earlier.
• Additional history of hypertension, hyperlipidemia, non-compliance with antiplatelet therapy and active tobacco abuse at time of presentation.
• Patient reported self-discontinuation of medications (aspirin (time unknown), statin, beta blocker) and resumed smoking.
• Clopidogrel was discontinued by his primary physician 97 days prior to presentation
• Initial electrocardiogram revealed a lateral ST elevation MI and the patient was taken to the cardiac catheterization lab …

A Comparison Of The Who 2004 And 2010 Classification Systems In Pancreatic Neuroendocrine Tumors (Pancreatic Net), James P. Casey, Md, Aakanksha Asija, Md, Anthony J. Prestipino, M.D., Jocelyn A. Sendecki, Md, Jonathan Brody, Md, Harish Lavu, Md, Jordan M. Winter, Md, Charles Yeo, Md, Ashwin R. Sama, Md, Madhaven V. Pillai, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Pancreatic NETs are rare tumors with multiple classification systems. Previous classification systems included tumor size, histologic grade, mitoses, Ki67, and metastases. The current WHO 2010 system utilizes mitotic rate and Ki67% to assign a grade. We compared the WHO 2004 and 2010 classification systems in predicting mortality and metastasis.

Pathologic parameters were used to classify 50 cases of Pancreatic NET according to the WHO 2004 and WHO 2010 systems. The relationship between the WHO 2004 and WHO 2010 grading was investigated using an exact Chi squared test. WHO grade categorization was next explored by vital status, by the exact method, …

Defining The Clinical Role Of Adapted Digital Light Field Photography In The Treatment Of Hiv-Induced Kaposi's Sarcoma Lesions, Jacquelyn Knapp, Gabriel Prager, Rui Bastos, Md, Susannah K. Graves, Md, Rolanda Carmen Manuel, Md, Yu-Tsueng Liu, Md, Phd

CwiC-PH

Kaposi’s sarcoma (KS): a vascular tumor associated with HHV8 and HIV infection

KS burden at Maputo Central Hospital (MCH):

•Referral center for all of southern Mozambique, 1500 beds, >65% HIV+ patients on medical services

•Dermatology ward: 50 beds, >30% of admitted patients suffer from Kaposi’s sarcoma and its complications

•10-15 cases/month admitted with advanced KS; additional 15-20 cases/month treated outpatient

•KS is the most common form of malignancy seen at MCH among men, second most frequent among women

Current KS standard of care:

•First line treatment: chemo- and concomitant antiretroviral-therapy

•Pre-treatment photographs rarely taken to establish a baseline for therapeutic …

Nut Midline Carcinoma In A Pregnant Woman, Jill N. D'Souza, Md, David M. Cognetti, Md, Ryan N. Heffelfinger, Md, James J. Evans, Md, Madalina Tuluc, Md, Jurij R. Bilyk, Marc R. Rosen, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

NUT midline carcinoma is a rare, highly aggressive tumor that involves midline structures, particularly in the head, neck and mediastinum. It is characterized by NUT gene translocations on chromosome 15. It typically impacts teenagers or young adults, and has a fulminant course leading to death in less than a year in most cases despite aggressive chemoradiotherapy. Due to its location, this tumor is frequently considered inoperable. We present a case of a sinonasal NUT midline carcinoma with orbital invasion discovered during the workup of sinusitis in a young, pregnant woman. The tumor was managed with definitive excision to negative margins …

Succinate Dehydrogenase Deficiency In Sporadic Pituitary Adenomas: A Potential Mechanism For Tumorigenesis, Edward Andrews, Md, Stacey K. Mardekian, Md, Markku Miettinen, Mark T. Curtis, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

In order to determine whether succinate dehydrogenase (SDH) deficiency plays a role in spor-adic, non-familial pituitary adenomas, we analyzed 80 pituitary adenomas for SDH deficiency from patients without familial tumor syndromes or without known SDH deficiency-associated neoplasms. SDH deficiency was determined by immunohistochemical (IHC) stains for SDHB since the loss of any of the four SDH subunits results in the loss of SDHB expression. Three pituitary adenomas showed complete loss of SDHB staining, and of these two also showed loss of SDHA staining. We further characterized these adenomas by looking at Ki67, IGF1R, and 5-hmC levels via IHC. SDHx …

Neonatal Abstinence Syndrome In Methadone Exposed Infants: Role Of Genetic Variability, Andrea L. Fielder, J. K. Coller, M. R. Hutchinson, Ross R. Haslam, Nona Lu, Susan C. Adeniyi-Jones, Michelle Ehrlich, Walter K. Kraft

Department of Pharmacology and Experimental Therapeutics Posters

Poster presented at: CPDD Scientific Meeting, San Juan, PR.

Aims: NAS incidence & severity in infants exposed to methadone during gestation is independent of maternal methadone dose. The incidence & severity of NAS could be in part due to genetic variability of key genetic loci related to opioid response; the interleukin-1beta (IL-1B) & mu opioid receptor (OPRM1) genes. This study aimed to investigate the impact of genetic variability in IL-1B -31 or OPRM1 A118G on NAS incidence (treatment required) & severity (dose of morphine).

Methods: This pilot study collected cheek cells from 71 methadone exposed infants; 46 …

Results Of A Phase I Study Of Bendamustine In Combination With Ofatumumab, Carboplatin And Etoposide (Boce) For Refractory Of Relapsed Aggressive B-Cell Non Hodgkin's Lymphomas (Nhl), Sameh Gaballa, Md, Neil D. Palmisiano, Md, Aakanksha Asija, Md, Andrew Chapman, Do, Jennifer K. Cloud, Bs, Joanne Filicko-O'Hara, Md, Lewis Rose, Md, Michael Ramirez, Md, Onder Alpdogan, Md, Neal Flomenberg, Md, Barbara Pro, Md, Elena Gitelson, Md, Phd, Mark Weiss, Md

Department of Medical Oncology Faculty Papers

Introduction:

• There are a number of regimens used to treat relapsed/refractory aggressive lymphomas and little consensus exists on the best salvage treatment.
• No regimen has shown clear superiority but uniformly there was an inferior outcome among patients who had relapsed after a prior rituximab containing regimen.
• Ofatumumab is a fully human IgG1k monoclonal anti-CD20 antibody. It recognizes a distinct epitope on the human CD20 molecule. In vitro studies with ofatumumab have shown more complement dependent cytotoxicity than rituximab.
• Bendamustine has single agent activity in relapsed aggressive lymphomas and has a favorable safety profile.

Objectives:

• We conducted a phase I trial …

Comparison Of Two Quantitative Image Analysis Systems For Breast Cancer Immunohistochemistry, Reid H. Phillips, Bs, Sue Direnzo, Bs, Charalambos C. Solomides, Md

Department of Pathology Honors Program Student Research Symposium

Automated image analysis systems for breast cancer immunohistochemistry promise efficiency and reliability in the quantification of therapy targets such as the estrogen receptor (ER) or human epidermal growth factor receptor (Her2). Thomas Jefferson University Hospital owns two such systems, the Aperio ScanScope AT (Leica Biosystems) and Ventana iScan Coreo (Roche). A comparison study was performed to determine if choice of system affects target quantification and subsequent clinical tumor classification. Tumor expressions of ER, progesterone receptor (PR), proliferation marker Ki67, and Her2 were quantified with both systems for tissue samples from twenty breast cancer patients. Positive tumor classification was based on …

Evaluating The Utility Of Thyroglobulin Wash Testing In The Management Of Well-Differentiated Thyroid Carcinoma, Katelyn M. Seither, Rossitza Draganova-Tacheva, Md

Department of Pathology Honors Program Student Research Symposium

Introduction

• Thyroid cancer is the most common endocrine neoplasm worldwide, representing 1.7% of new cancer diagnoses and 0.5% of cancer deaths each year (Baldini et al.)
• The majority of thyroid cancers are primary (originating within the gland itself), are well-differentiated, and are derived from follicular epithelial cells
• Papillary thyroid cancer is the most common subtype

70-80% of all thyroid cancers

Peak incidence in women of child-bearing age

Generally indolent behavior, excellent prognosis with total thyroidectomy

30-90% of patients exhibit recurrent or persistent metastasis to the cervical lymph nodes (Torres et al.) and 20% of cases present with occult cancer that …

The Intersection Between Hpv And Hiv Infections: Is There An Increased Susceptibility To Hiv Acquisition In Hpv-Infected Women?, Montida Fleming, Ba, Fred Gorstein, Md

Department of Pathology Honors Program Student Research Symposium

It has been well documented that HIV infection is associated with HPV infection and the progression to cervical carcinoma. Since the spread of HIV/AIDS epidemic, HPV-related cervical carcinoma had such a high prevalence in HIV-infected individuals that it became established as an AIDS-defining illness. Cervical cancer is the most common AIDS-related malignancy, and the sixth most common presenting AIDS-defining illness in women.¹ Additionally, HIV infection leads to a 5-fold increase in multiple new HPV infections within 6 weeks of seroconversion.² Not only does HIV impact acquisition of HPV at molecular and cellular levels, HIV and HPV viruses interact …

20 Year-Old Male With Destructive Lesion Of Orbital Roof, Paris A. Barkan, Bs, Lawrence C. Kenyon, Md, Phd

Department of Pathology Honors Program Student Research Symposium

Patient History

Mr. G.R. is a 20-year-old man with no significant past medical history. He presented in July of 2013 with two months of worsening pain over the right orbit. Periorbital edema was also present. Initial treatment with eye drops, antibiotics (erythromycin followed by cephalexin), and steroids (prednisone) failed to control his symptoms.

In October of 2013, CT and MRI scans revealed a permeative destructive lesion centered in the right orbital roof with extension into the superior orbit and the floor of the anterior cranial fossa. There was no abnormal enhancement in the visualized brain parenchyma.

The radiologic appearance of …

Mechanisms That Modify Immune Response In Neonatal Alloimmune Thrombocytopenia, Robert Cooper, Jay H. Herman

Department of Pathology Honors Program Student Research Symposium

What is NAIT?

Neonatal alloimmune thrombocytopenia (NAIT) is a form of fetal and neonatal thrombocytopenia caused by maternal-fetal platelet antigen incompatibility that results in placental transfer of maternal IgG alloantibodies against the platelet antigen. Currently, there are 28 human platelet antigen systems (HPA) that are polymorphisms of various membrane glycoprotein (GP) integrins. The first HPA and most immunogenic was discovered in the 1960’s and is now termed HPA-1, a diallelic system with HPA-1a and HPA-1b on the GPβ3 subunit of the fibrinogen receptor (Murphy). Approximate HPA-1 phenotype frequencies are: homozygous 1a,1a (~70%); heterozygous 1a,1b (~28%); homozygous 1b,1b (~2%).

Typically an …

Lead Toxicity: What Is It And How Is It Happening?, Kimberly A. Parada, Ba, Jay S. Schneider, Phd

Department of Pathology Honors Program Student Research Symposium

EPIDEMIOLOGY

Lead poisoning accounts for 0.6% of the global burden of disease.

In Pennsylvania in 2010, 148,751 children under 72 months of age were tested for blood lead levels. Of those children, 19,176 had blood lead levels greater than 5 μg/dl.

• A lower socioeconomic status increases the chances for lead exposure.
• Lead toxicity is an under-appreciated problem that is entirely preventable.

Hiv Associated Neurocognitive Disorders In An Antiretroviral Therapy Era, Molly Halloran, David S. Strayer, Md, Phd

Department of Pathology Honors Program Student Research Symposium

HIV emerged as a major threat to world health over 30 years ago, and while its effects on the immune system are widely known, HIV also has broad and devastating effects on the nervous system. Despite our potent antiretroviral therapies (ART), these HIV-associated neurocognitive disorders (HAND) continue to afflict HIV infected individuals. With over 33 million people infected worldwide and evidence that neurological damage can accrue in virologically well controlled individuals, HAND is a pressing challenge. Nevertheless, many questions remain unanswered about this spectrum of disorders.

Her-2 Heterogeneity In Breast Cancer: A Case Study, Kinnari Patel, Theodore Parsons

Department of Pathology Honors Program Student Research Symposium

CASE

The patient is a 75 year-old female with a history of stage 1 invasive ductal carcinoma of the left breast measuring 1.2 cm. Core biopsy of the mass demonstrated Nottingham grade 3 invasive ductal carcinoma; ER negative, PR negative, HER-2 negative (1+). The patient underwent mastectomy in April 2013. Mastectomy confirmed Nottingham grade 3 invasive ductal carcinoma pT1c/pN0/pMX with peritumoral lymphovascular invasion and invasive tumor less than 1 mm from the superoanterior margin. Due to comorbidities the patient was not considered a candidate for adjuvant chemotherapy.

In January 2014 the patient presented with a mastectomy site recurrence. Needle core …

Plasmapheresis And Hiv-Associated Thrombotic Microangiopathy: An Institutional Review, Megan Fisher, Ms2, Nancy Edger Hall, Rn, Mba, Jennifer Webb, Md, Julie Karp, Md

Department of Pathology Honors Program Student Research Symposium

Thrombotic thrombocytopenic purpura (TTP) is a systemic disorder that classically results from a deficiency in the von Willebrand factor-cleaving enzyme, ADAMTS13. The human immunodeficiency virus (HIV) is a secondary cause of TTP. It has been recognized that some patients with HIV-associated TTP do not have a deficiency in ADAMTS13 activity. The role of plasmapheresis (PLEX) in these patients is unclear. This study reviewed 8 cases of HIV-associated TTP at Thomas Jefferson University Hospital. All patients responded to treatment; however, we were unable to make any conclusions regarding the use of PLEX in patients with normal ADAMTS13 activity. HAART initiation is …

Molecular Profiling Of Patients With Non Small Cell Lung Cancer At Jefferson University Hospital, Erin Bange, Renu Bajaj, Ms, Phd, Cg (Ascp), Cm, Facmg

Department of Pathology Honors Program Student Research Symposium

Companion diagnostics is the use of specific tests whose results are linked to a particular drug. It allows clinicians the ability to better target the mechanism of pathology in the patient and follow it up with a therapy specifically designed to treat the disease process at hand. This approach to medicine has particularly been championed in the field of oncology with the development of such drugs as Zelboraf for the treatment of metastatic melanoma with the BRAFV600 mutation or Xalkori for late stage lung cancer expressing an abnormal ALK protein. In the case of non-small cell lung cancer (NSCLC) Jefferson …

Personalized Immune Therapy For Cancer A Potential Game-Changing Treatment, Emily Evron, Emanual Rubin, Md

Department of Pathology Honors Program Student Research Symposium

T-CELL RECEPTOR, NORMALLY

T-cell receptors reside on the surface of T-cells, and recognize a specific antigen presented by an MHC molecule

Next, the T-cells become either CD4 or CD8 cells

Co-stimulation is a key step in activating the T-cell; B7 proteins on the surface of antigen-presenting cells interact with CD28/CTLA-4 receptors on the T-cell.

Peripheral T-Cell Lymphoma Arising From Age-Related Ebv-Associated Lymphoproliferative Disorder (Ar-Ebvlpd), Alaina Chodoff, Msii, Guldeep Uppal, Md, Jerald Z. Gong, Md

Department of Pathology Honors Program Student Research Symposium

In the setting of underlying immune suppression, Epstein Barr Virus (EBV) is a well-recognized oncogenic agent that induces the malignant proliferation of B-cells. EBV-lymphoproliferative disorders (LPDs) have recently been linked to immunosenescence. We present a unique case of Age-Related EBV-Lymphoproliferative Disorder (AR-EBVLPD) in a 70 year old female that deviates from the characteristic progression of this disease. Over the course of 18 months, the patient’s clinical condition worsened without a definitive diagnosis to explain the severe, atypical widespread chronic inflammation spanning her gastrointestinal tract, from esophagus to small bowel. The diagnosis of AR-EBVLPD, polymorphic extranodal subtype, was delayed until the …

Giant Cell Tumor Of Soft Tissue: A Case Study, Rachel Schneider, Brian J. O'Hara

Department of Pathology Honors Program Student Research Symposium

BACKGROUND

Giant cell tumors of soft tissue are relatively uncommon tumors. They are considered to be the soft tissue counterpart to giant cell tumors of bone. Both tumors consist of multi-nucleated giant cells evenly distributed throughout a background of epithelioid mononuclear cells, and are usually benign, but can be locally invasive. Giant cell tumors of soft tissue typically occur in patients over age 40, and show no gender or racial predilection. They present as firm, well demarcated masses, which are not connected to the underlying muscle, tendon, or bone. Giant cell tumors of soft tissue are generally small, and tend …

Fibrosing Cholestatic Hepatitis C Post-Liver Transplantation: A Case Study, Layla Hatem, Wei Jiang, Md, Phd

Department of Pathology Honors Program Student Research Symposium

Introduction:

Liver Transplantation:

• Hepatitis C infection is the most common indication for liver transplantation in the US
• HCV infection of the liver allograft occurs within hours from circulating virions.

-Serum RNA levels are observed in the first several weeks.

-Acute hepatitis occurs in 2-6 months

-Chronic hepatitis occurs in 3-9 months

***Persistence of HCV infection is the rule after transplantation due to immune suppression

Chronic recurrent HCV infection post transplantation

• There are four distinct patterns of recurrent chronic HCV in the liver allograft.

-Usual chronic HCV (>70%)

-Fibrosing Cholestatic Hepatitis C (5-10%)

-Plasma cell-rich HCV

-HCV overlapping with rejection …