Medicine and Health Sciences Commons^™

Exploring Referral And Service Utilization Patterns Within An Outpatient Interdisciplinary Pediatric Chronic Pain Program, Aimee Hildenbrand, Christina M Amaro, Benjamin Bear, Catherine Soprano, Katherine S Salamon

Department of Medicine Faculty Papers

PURPOSE: We examine referral sources and clinical characteristics for youth presenting to an outpatient interdisciplinary pediatric chronic pain program.

PATIENTS AND METHODS: Referral data were extracted from the electronic health record. PROMIS Pediatric Anxiety and Pain Interference Scales were administered at an initial evaluation visit.

RESULTS: The program received 1488 referrals between 2016 and 2019, representing 1338 patients, with increasing volume of referrals over time. Referrals were primarily from orthopedics (19.6%), physical medicine and rehabilitation (18.8%), neurology (14.4%), and rheumatology (12.6%). Patients referred were primarily female (75.4%), White (80.1%), English-speaking (98.4%) adolescents (median=15.0 years). Of those referred, 732 (54.7%) attended …

Comprehensive Review Of Acute Pancreatitis Pain Syndrome, Jacob Beiriger, Adnan Khan, Brian Yan, Heather Ross, Makala Wang, Michael Carducci, Natali Salinas, Salil Chowdhury, Ryan Erwin, Sarah Chen, Alexis Gerber

Jefferson Hospital Staff Papers and Presentations

Pancreatitis is a condition that causes inflammation in the pancreas, an organ located behind the stomach. This condition often presents as neuropathic, inflammatory, and/or visceral pain. Acute pancreatitis is typically characterized by sudden and severe abdominal pain, often in the upper right part of the abdomen. The pain from pancreatitis can be caused by different mechanisms, such as abnormal activation of pancreatic zymogens or NF-κB mediated inflammation in the pancreas. The treatment of pancreatitis depends on its type, severity, and underlying cause. Hospitalization and medications are typically necessary, while in others, surgery may be required. Proper management of pancreatitis is …

Point And Counterpoint: Polatuzumab Vedotin In The Front-Line Therapy For Diffuse Large B- Cell Lymphoma, Colin Thomas, Sameep Thapa, Connor Mclaughlin, Molly Halloran, Porcu Pierluigi

Department of Medical Oncology Faculty Papers

No abstract provided.

Co-Management Strategies For Acute Myeloid Leukemia Patients In The Community Setting, Christopher Benton, Michael R Grunwald, Hana Safah, Margaret Kasner

Department of Medical Oncology Faculty Papers

The treatment landscape for acute myeloid leukemia (AML) has changed substantially in recent years. The introduction of newer therapies, including oral agents, less myelosuppressive agents, and parenteral regimens suitable for outpatient administration, has made it feasible for select patients to receive therapy in the outpatient setting and in community practices. Thorough patient evaluation (including molecular testing), planned supportive care (eg, transfusion support, antimicrobial prophylaxis), and vigilant patient monitoring (for tumor lysis syndrome and adverse events) by a multidisciplinary team are required for successful management of patients both in the community and at specialized leukemia centers. Some patients are unable or …

Treatment Of Severe Swallowing Dysfunction In Systemic Sclerosis With Ivig: Role Of Antimuscarinic Antibodies, Fabian A Mendoza, Anthony J. Dimarino, Sidney Cohen, Christopher Adkins, Shady Abdelbaki, Satish Rattan, Christopher Cao, Susie Denuna-Rivera, Sergio A. Jimenez

Division of Gastroenterology and Hepatology Faculty Papers

Oropharyngeal and esophageal dysmotility can cause serious clinical complications such as aspiration pneumonia, cachexia, and sarcopenia, with a resulting increase in mortality and disability. The current standard of care for the treatment of SSc-associated swallowing dysfunction is mainly supportive, although severe cases are usually refractory to conventional management. Recent studies have shown that the abnormal production of functional autoantibodies such as anti-cholinergic muscarinic receptor III antibodies may participate in the pathogenesis of SSc-associated gastrointestinal dysmotility and may provide a novel target for therapeutic intervention. We describe two patients with severe and rapid onset of SSc-associated severe swallowing dysfunction and esophageal …

Editorial: Nk/T-Cell Lymphoma: Biology, Prognostics, Prediction, And Treatment, Jean El Cheikh, Khodr Terro, Layal Sharrouf, Anjali Mishra, Marcos De Lima

Department of Medical Oncology Faculty Papers

No abstract provided.

Role Of Atogepant In The Treatment Of Episodic Migraines: Clinical Perspectives And Considerations, Fred Cohen, Hsiangkuo Yuan

Department of Neurology Faculty Papers

Advances in molecular biology and neuroscience have led to the discovery of calcitonin gene-related peptide (CGRP), a 37 amino-acid neuropeptide that plays a critical role in the pathogenesis of migraine. CGRP receptor antagonist, also known as gepant, is an oral medication that inhibits the CGRP-related nociceptive signaling pathway. To date, three gepants are approved by the FDA for migraine treatment. Atogepant is a 2nd-generation gepant that non-competitively antagonizes CGRP receptors inhibiting neurogenic inflammation and pain sensitization. With its long half-life and minimal cardiovascular or liver toxicity, it is the first in its class approved primarily for migraine prevention. This article …

Novel Approaches To Coronary Perforations: Everything But The Kitchen Sink., Dany Jacob, Michael P Savage, David L Fischman

Division of Cardiology Faculty Papers

No abstract provided.

Advances In The Diagnosis And Treatment Of Krabbe Disease, David A Wenger, Paola Luzi, Mohammad Rafi

Department of Neurology Faculty Papers

Krabbe disease is an autosomal recessive leukodystrophy caused by pathogenic variants in the galactocerebrosidase (GALC) gene. GALC activity is needed for the lysosomal hydrolysis of galactosylceramide, an important component of myelin. While most patients are infants, older patients are also diagnosed. Starting in 1970, a diagnosis could be made by measuring GALC activity in leukocytes and cultured cells. After the purification of GALC in 1993, the cDNA and genes were cloned. Over 260 disease-causing variants as well as activity lowering benign variants have been identified. While some pathogenic variants can be considered “severe,” others can be considered “mild.” The combination …

Coronary Vasospasm: Not Gone But Often Forgotten, Michael Savage, Tabitha Moe

Division of Cardiology Faculty Papers

No abstract provided.

Deep Supratentorial Extension Is Associated With Poor Clinical Outcomes After Glioblastoma Resection, Adam Barsouk, Michael P. Baldassari, Omaditya Khanna, Donald Ye, Erica Cunningham, Christopher Farrell, David Andrews, James Evans, Kevin Judy

Phase 1

Introduction: Glioblastoma (GBM) often extends to deep supratentorial locations, which limits the extent of maximal safe resection. Deep supratentorial extension (DSE) may be a clinically convenient prognostic indicator following GBM resection.

Methods: 582 GBM resections from 2012-2018 were retrospectively reviewed. DSE was defined as tumoral extension to the basal ganglia, thalamus, corpus callosum, internal capsule, hypothalamus, caudate, or putamen as identified on preoperative imaging.

Results: DSE was identified in 32.9% cases (192), while 52.5% (306) involved only superficial supratentorial locations (frontal, parietal, temporal and occipital lobes). Within the DSE cohort, the most commonly affected anatomical locations were the corpus …

Us-Triggered Microbubble Destruction For Augmenting Hepatocellular Carcinoma Response To Transarterial Radioembolization: A Randomized Pilot Clinical Trial., John R Eisenbrey, Flemming Forsberg, Corinne E Wessner, Lauren J Delaney, Kristen Bradigan, Sriharsha Gummadi, Mohamed Tantawi, Andrej Lyshchik, Patrick O'Kane, Ji-Bin Liu, Charles Intenzo, Jesse Civan, Warren Maley, Scott W Keith, Kevin Anton, Allison Tan, Amanda Smolock, Susan Shamimi-Noori, Colette M Shaw

Department of Radiology Faculty Papers

Combined US-triggered microbubble destruction and hepatocellular carcinoma radioembolization showed improved treatment response compared with radioembolization alone and no changes in vital signs or liver function.

Background US contrast agents are gas-filled microbubbles (MBs) that can be locally destroyed by using external US. Among other bioeffects, US-triggered MB destruction, also known as UTMD, has been shown to sensitize solid tumors to radiation in preclinical models through localized insult to the vascular endothelial cells.

Purpose: To evaluate the safety and preliminary efficacy of combining US-triggered MB destruction and transarterial radioembolization (TARE) in participants with hepatocellular carcinoma (HCC).

Materials and Methods: In this …

Outcomes Of Mechanical Circulatory Support For Giant Cell Myocarditis: A Systematic Review, Preeyal M. Patel, Abhiraj Saxena, Chelsey T. Wood, Mfa, Thomas J. O'Malley, Elizabeth Maynes, John W..C. Entwistle, H. Todd Massey, Preethi R Pirlamarla, René J Alvarez, Leslie T Cooper, J. Eduardo Rame, Vakhtang Tchantchaleishvili

Division of Cardiology Faculty Papers

Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32–57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) …

Diagnostic Journey And Impact Of Enzyme Replacement Therapy For Mucopolysaccharidosis Iva: A Sibling Control Study., Can Ficicioglu, Dena R Matalon, Nicole Luongo, Caitlin Menello, Tracy Kornafel, Andrew J Degnan

Abington Jefferson Health Papers

BACKGROUND: Mucopolysaccharidosis (MPS) IVA, also known as Morquio A syndrome, is a rare autosomal recessive lysosomal storage disorder caused by a deficiency in the enzyme N-acetylgalactosamine-6-sulfatase. Early recognition, diagnosis, and treatment of this progressive, multisystem disease by enzyme replacement therapy (ERT) can lead to improved outcomes and reduced mortality.

METHODS: This report documents the diagnostic journey and treatment with ERT of three siblings with MPS IVA. Clinical outcome measures included growth, endurance, imaging, cardiac, respiratory, ophthalmology, and laboratory evaluations.

RESULTS: Three siblings, diagnosed at 14.7, 10.1, and 3.2 years of age, demonstrated clinical improvement with weekly infusions of 2.0 mg/kg …

Management Of Acute Ischemic Stroke., Franziska Herpich, Fred Rincon

Department of Neurology Faculty Papers

OBJECTIVES: Concise "synthetic" review of the state of the art of management of acute ischemic stroke.

DATA SOURCES: Available literature on PubMed.

STUDY SELECTION: We selected landmark studies, recent clinical trials, observational studies, and professional guidelines on the management of stroke including the last 10 years.

DATA EXTRACTION: Eligible studies were identified and results leading to guideline recommendations were summarized.

DATA SYNTHESIS: Stroke mortality has been declining over the past 6 decades, and as a result, stroke has fallen from the second to the fifth leading cause of death in the United States. This trend may follow recent advances in …

Chronic Muscle Pain, Michael Bozzi, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives ●How to approach the patient with chronic muscle pain ●How a complete history and physical can prevent extraneous testing and unnecessary or premature referrals ●Treatment strategies

Head And Neck Injuries For The Pcp, Greta Bires, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

• Define and recognize common symptoms and treatments of head and neck injuries
• Become more familiar and comfortable with the history and physical exam techniques of common head and neck injuries
• Know when to seek a higher level of care for certain common head and neck injuries

Role Of Echocardiography In Diagnostic Evaluation Of Patients Admitted To Observation Unit., Muhammad Arslan Cheema, Hafez Mohammad Ammar Abdullah, Waqas Ullah, Yasar Sattar, Shujaul Haq, Khadija Cheema, Asrar Ahmad, Zain Ali, Asoka Balaratna

Abington Jefferson Health Papers

BACKGROUND: Syncope is a transient loss of consciousness due to transient decrease in cerebral perfusion. Syncope accounts for a 3-6% of all emergency department visits. Etiology of syncope can be neural, cardiogenic, or vascular. Previous studies have evaluated the types and management of syncope. Echocardiography is a commonly used test in the evaluation of causes of syncope. Whether the benefit compared to financial burden of this diagnostic study is in all subsets of syncope cases remains unclear.

AIM: To evaluate the impact of echocardiography in the diagnostic evaluation of syncope and to evaluate the subset of patients that would benefit …

Clinical Value Of Ultrasonography For Monitoring Angular Pregnancy In First-Trimester, Yanhua Zhen, Md, Xuefeng Lu, Md, Chenyu Wang, Md, Huixia Li, Md, Ji-Bin Liu, Md

Department of Radiology Faculty Papers

Objective: To explore the clinical value of ultrasonography for early detection and monitoring of angular pregnancy during the first-trimester.

Methods: For this retrospective study, we enrolled 23 patients with asymptomatic angular pregnancy who were diagnosed by ultrasound at early pregnancy and who underwent ultrasound follow-up to determine its clinical outcome. An ultrasound unit E8 (GE Healthcare, Milwaukee, WI) associated with a 5-9 MHz convex array transvaginal probe was used to image the gestational sac by both two-dimensional and three-dimensional modes. Transvaginal sonographic observation included the location, size, and shape of the gestational sac, as well as the relationship between the …

Prevalence Of Dyskinesia And Off By 30-Minute Intervals Through The Day And Assessment Of Daily Episodes Of Dyskinesia And Off: Novel Analyses Of Diary Data From Gocovri Pivotal Trials., Robert A. Hauser, Daniel Kremens, Lawrence W. Elmer, David L. Kreitzman, Ryan R. Walsh, Reed Johnson, Robert Howard, Jack T. Nguyen, Rajiv Patni

Department of Neurology Faculty Papers

BACKGROUND: Parkinson's disease (PD) patients using levodopa commonly develop dyskinesia and OFF episodes that reduce quality of life.

OBJECTIVE: Evaluate prevalence of troublesome dyskinesia and OFF through the day, assessed by 30-minute intervals, as well as the mean number and duration of troublesome dyskinesia and OFF episodes, transitions between PD states, and effects of Gocovri® (amantadine) extended release capsules on these episodes.

METHODS: Evaluate diary data from pooled Gocovri phase 3, placebo-controlled trials-analyzed for 17 hours following wake-up-at baseline and week 12.

RESULTS: Diaries were evaluable for 162 patients. At baseline, 67% of patients woke up OFF, with prevalence decreasing …

Comparison Of Osteoporosis Pharmacotherapy Fracture Rates: Analysis Of A Marketscan® Claims Database Cohort, Alan W. Reynolds, Guodong Liu, Paul T. Kocis, Jenna N. Skowronski, Douglas L. Leslie, Edward J. Fox

Student Papers, Posters & Projects

Background: Several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. No study has compared real world efficacy at preventing fractures between all currently approved medications.

Objectives: To directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database.

Methods: The Truven Health Analytics MarketScan® database from 2008 - 2012 was used to identify all patients who started a new osteoporosis medication. Patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. …

A 6-Week Hip Muscle Strengthening And Lumbopelvic-Hip Core Stabilization Program To Improve Pain, Function, And Quality Of Life In Persons With Patellofemoral Osteoarthritis: A Feasibility Pilot Study., Lisa T. Hoglund, Laura Pontiggia, John D. Kelly

Department of Physical Therapy Faculty Papers

Background: Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA.

Methods: Ten females with PFJ …

Neurovascular Disorders: Novel Perspectives On Pathogenesis, Diagnosis, And Treatment., David Hasan, Nohra Chalouhi, Md, Aaron S Dumont, Robert M Starke, Pascal Jabbour Md

Department of Neurosurgery Faculty Papers

No abstract provided.

A Synthetic Lethality Screen Using A Focused Sirna Library To Identify Sensitizers To Dasatinib Therapy For The Treatment Of Epithelial Ovarian Cancer., Harsh B Pathak, Yan Zhou, Geetika Sethi, Jeff Hirst, Russell J Schilder, Erica A Golemis, Andrew K Godwin

Department of Medicine Faculty Papers

Molecular targeted therapies have been the focus of recent clinical trials for the treatment of patients with recurrent epithelial ovarian cancer (EOC). The majority have not fared well as monotherapies for improving survival of these patients. Poor bioavailability, lack of predictive biomarkers, and the presence of multiple survival pathways can all diminish the success of a targeted agent. Dasatinib is a tyrosine kinase inhibitor of the Src-family kinases (SFK) and in preclinical studies shown to have substantial activity in EOC. However, when evaluated in a phase 2 clinical trial for patients with recurrent or persistent EOC, it was found to …

Management Of Cerebral Cavernous Malformations: From Diagnosis To Treatment, Nikolaos Mouchtouris, Nohra Chalouhi, Md, Ameet Chitale, Robert Starke, Stavropoula Tjoumakaris, Robert H. Rosenwasswer Md, P. M. Jabbour

Department of Neurosurgery Faculty Papers

No abstract provided.

Integrated Guidance On The Care Of Familial Hypercholesterolaemia From The International Fh Foundation., Gerald F Watts, Samuel Gidding, Anthony S Wierzbicki, Peter P Toth, Rodrigo Alonso, W Virgil Brown, Eric Bruckert, Joep Defesche, Khoo Kah Lin, Michael Livingston, Pedro Mata, Klaus G Parhofer, Frederick J Raal, Raul D Santos, Eric J G Sijbrands, William G Simpson, David R Sullivan, Andrey V Susekov, Brian Tomlinson, Albert Wiegman, Shizuya Yamashita, John J P Kastelein

Division of Cardiology Faculty Papers

Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL) cholesterol and causes premature coronary heart disease. There are at least 20million people with FH worldwide, but the majority remain undetected and current treatment is often suboptimal. To address this major gap in coronary prevention we present, from an international perspective, consensus-based guidance on the care of FH. The guidance was generated from seminars and workshops held at an international symposium. The recommendations focus on the detection, diagnosis, assessment and management of FH in adults and children, and set guidelines for clinical …

Old Remedies For Epilepsy: Avicenna's Medicine., A A Asadi-Pooya, A R Nikseresht, E Yaghoubi

Department of Neurology Faculty Papers

BACKGROUND: The history of epilepsy and its treatments dates back to at least 4 millennia. Avicenna, c. 980 AD in Bukhara, Khorasan-1037 in Hamedan was a Persian-speaking Iranian physician, who has many recommendations and suggested various therapies for epilepsy in his book, The Canon of Medicine.

METHODS: We first reviewed the most important ancient treatments for epilepsy mentioned by Avicenna and considered those as the key words for our next step. Then, we made a literature search (medline and scopus) with those key words to find out new scientific findings in modern medicine about the Avicenna's suggestions.

RESULTS: Among the …

Treatment Of Cerebrospinal Fluid Leak During Spinal Cord Stimulator Implantation With Epidural Blood Patches, Farid Kia, Md, Linqiu Zhou, Md, Jason Berk, Md

Department of Rehabilitation Medicine Faculty Papers

Conclusion:

Our data is consistent with prior studies in demonstrating that the incidence of dural puncture and CSF leak with SCS procedures is rare. Based on our experiences, performing an epidural blood patch intra-operatively on the contra-lateral side under fluoroscopy could prevent PDPH. This treatment should especially be considered in patients undergoing SCS trials in order to accurately assess the level of pain reduction. Patients with prior spine surgeries might pose higher risks for dural puncture and more extensive pre-operative assessment could be beneficial.

Psychiatric Comorbidity In Transformed Migraine: Presentation, Treatment, Impact And Outcome, Muhammad A. Abbas M.D, Haseeba Ismaiel, M.D, William B. Young M.D., Mary Hopkins, Stephen D. Silberstein, M.D

Jefferson Journal of Psychiatry

Transformed migraine is one of the subtypes of chronic daily headache (CDH), and is similar to chronic migraine, described in the new International Headache Society (IHS) classification 2004. The term CDH refers to the Headache disorders experienced 15 or more days a month and includes headaches associated with medication overuse. CDH can be divided into primary and secondary varieties. Primary CDH is not related to a structural or systemic illness. It includes diseases such as Transformed migraine (TM). Chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). Secondary CDH has an identifiable underlying cause, including post-traumatic …

Evolving Role Of Vorinostat Combined With Radiation Therapy In The Treatment Of Brain Tumors, From The Lab To The Clinic, Y. R. Lawrence, P. Wachsberger, Y. Liu, B. Andersen, A. P. Dicker

Bodine Journal

Purpose/Objective(s): Radiation therapy (RT) is a critical element in the treatment of both brain metastases and glioblastoma (GBM). Temozolomide (TMZ) has an established role in the upfront treatment of GBM. Down-regulated mismatch repair (MMR) is a known mechanism of resistance to TMZ. Vorinostat (SAHA), an HDAC inhibitor, has successfully been combined with a number of cytotoxic agents, including ionizing radiation (IR). We performed a series of preclinical and clinical studies to examine the role of SAHA in the treatment of brain tumors.

American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, CA