Medicine and Health Sciences Commons^™

An Approach To Refractory Hypoxemia, Daniel Garrido, Md, Evan Nardone, Md, Mark Mallozzi, Md

The Medicine Forum

A 74-year-old female with no significant pulmonary history presented as a transfer from an outside hospital for persistent refractory hypoxemia.

Bilateral Intercostal Lung Herniations: A Rare Incidental Finding In A Dyspneic Patient, Jillian Cooper, Md, Christine Kurian, Md

The Medicine Forum

A 63-year-old man with a past medical history of chronic obstructive pulmonary disease (COPD), stage IV sarcoidosis on 3-4 liters of home oxygen and chronic prednisone, moderate aortic stenosis, and a prior aspergilloma for which he had a left upper lobe lung resection presented to the hospital with two weeks of worsening shortness of breath.

Genomic Characterization Of Malignant Progression In Neoplastic Pancreatic Cysts, Michaël Noë, Noushin Niknafs, Catherine G Fischer, Wenzel M Hackeng, Violeta Beleva Guthrie, Waki Hosoda, Marija Debeljak, Eniko Papp, Vilmos Adleff, James R White, Claudio Luchini, Antonio Pea, Aldo Scarpa, Giovanni Butturini, Giuseppe Zamboni, Paola Castelli, Seung-Mo Hong, Shinichi Yachida, Nobuyoshi Hiraoka, Anthony J Gill, Jaswinder S Samra, G Johan A Offerhaus, Anne Hoorens, Joanne Verheij, Casper Jansen, N Volkan Adsay, Wei Jiang, Jordan Winter, Jorge Albores-Saavedra, Benoit Terris, Elizabeth D Thompson, Nicholas J Roberts, Ralph H Hruban, Rachel Karchin, Robert B Scharpf, Lodewijk A A Brosens, Victor E Velculescu, Laura D Wood

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) are non-invasive neoplasms that are often observed in association with invasive pancreatic cancers, but their origins and evolutionary relationships are poorly understood. In this study, we analyze 148 samples from IPMNs, MCNs, and small associated invasive carcinomas from 18 patients using whole exome or targeted sequencing. Using evolutionary analyses, we establish that both IPMNs and MCNs are direct precursors to pancreatic cancer. Mutations in SMAD4 and TGFBR2 are frequently restricted to invasive carcinoma, while RNF43 alterations are largely in non-invasive lesions. Genomic analyses suggest an average window of over three …

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

The Effect Of Neighborhood Social Environment On Prostate Cancer Development In Black And White Men At High Risk For Prostate Cancer, Shannon M Lynch, Elizabeth Handorf, Kristen A Sorice, Elizabeth Blackman, Lisa Bealin, Veda N. Giri, Elias Obeid, Camille Ragin, Mary Daly

Department of Medical Oncology Faculty Papers

INTRODUCTION: Neighborhood socioeconomic (nSES) factors have been implicated in prostate cancer (PCa) disparities. In line with the Precision Medicine Initiative that suggests clinical and socioenvironmental factors can impact PCa outcomes, we determined whether nSES variables are associated with time to PCa diagnosis and could inform PCa clinical risk assessment.

MATERIALS AND METHODS: The study sample included 358 high risk men (PCa family history and/or Black race), aged 35-69 years, enrolled in an early detection program. Patient variables were linked to 78 nSES variables (employment, income, etc.) from previous literature via geocoding. Patient-level models, including baseline age, prostate specific antigen (PSA), …

Sports Medicine Update For The Primary Care Physician, Joshua V. Okon, Md

Department of Family & Community Medicine Presentations and Grand Rounds

AGENDA:

• OA vs Degenerative meniscal tear
• Review of OA diagnosis
• Degenerative Meniscal tears
• Management of degenerative meniscal tears and OA
• Rotator Cuff Pathology

Post Traumatic Stress In Families With Pediatric Illness, Olivia Seecof, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline

• Behavioral Science Topic
• Introduce post traumatic stress in parents and children
• Talk specifically about post traumatic stress in families with pediatric (Cancer diagnoses, Type 1 diabetes diagnoses, Traffic accidents)
• Discuss relationship of PTSS in parents, children and siblings
• Apply what we’ve learned (Trauma-informed care)

Efficacy And Safety Of Bempedoic Acid For Prevention Of Cardiovascular Events And Diabetes: A Systematic Review And Meta-Analysis., Xing Wang, Yu Zhang, Huiwen Tan, Peng Wang, Xi Zha, Weelic Chong, Liangxue Zhou, Fang Fang

Department of Medicine Faculty Papers

BACKGROUND: Bempedoic acid is an oral, once-daily, first-in-class drug being developed for the treatment of hyperlipidemia. However, evidence of bempedoic acid use for the prevention of cardiovascular events and diabetes is lacking. Thus, we aim to evaluate the benefit and safety of bempedoic acid use for the prevention of cardiovascular events and diabetes.

METHODS: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials with no language restriction from inception until March 3, 2020. Pairs of reviewers independently identified randomized controlled trials comparing the use of bempedoic acid with placebo or no treatment for primary prevention of cardiovascular …

Atypical Reactivation Of Varicella Zoster Virus Associated With Pancreatitis In A Heart Transplant Patient., Christine Shieh, Ashley Barnes, Drew Johnson, Ilya Danelich, Pharmd, Bcps, Bccp, Preethi Pirlamarla, Rene Alvarez, H. Todd Massey, Md, Mahek Shah

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND Acute pancreatitis is rare following solid organ transplantation but is associated with high mortality. It has been most commonly reported following renal transplant but can occur with other solid organ transplantations. CASE REPORT A 46-year-old male who had an orthotopic heart transplant 6 months ago presented with a 3-week history of abdominal pain. The patient described it as intermittent, sharp, and stabbing, originating in the periumbilical area and radiating to the back. His lipase was elevated at 232 U/L. Given that the patient's symptoms and lipase were elevated to greater than three times the upper limit of normal, he …

Big Data Analytics Applied To Healthcare, Xuejuan Zhang, Boris Vishnevsky

School of Continuing and Professional Studies Student Papers

In this paper, we review the recent literature related to Big Data Analytics (BDA). We also discuss ways of applying BDA in Healthcare. In Section 1, we discuss the definition of Big Data Analytics and its characteristics. In Section 2, we discuss the healthcare ecosystem's main stakeholders and the data of each main stakeholder. Section 3 discusses the challenges and opportunities of leveraging Big Data Analytics by healthcare stakeholders.

1-Chromonyl-5-Imidazolylpentadienone Demonstrates Anti-Cancer Action Against Tnbc And Exhibits Synergism With Paclitaxel, Karan Modi, Scott Lawson, Guanglin Chen, Deepthi Tumuluri, Inga Rekhtman, Michael Kurtz, G Cristina Brailoiu, Qiao-Hong Chen, Ashakumary Lakshmikuttyamma

College of Pharmacy Faculty Papers

Curcumin has been well studied for its anti-oxidant, anti-inflammatory, and anti-cancer action. Its potential as a therapy is limited due to its low bioavailability and rapid metabolism. To overcome these challenges, investigators are developing curcumin analogs, nanoparticle formulations, and combining curcumin with other compounds or dietary components. In the present study, we used a 1-chromonyl-5-imidazolylpentadienone named KY-20-22 that contains both the pharmacophore of curcumin and 1,4 benzopyrone (chromone) moiety typical for flavonoids, and also included specific moieties to enhance the bioavailability. When we tested the in vitro effect of KY-20-22 in triple-negative breast cancer (TNBC) cell lines, we found that …

The Generation Of An Engineered Interleukin-10 Protein With Improved Stability And Biological Function, Faisal Minshawi, Sebastian Lanvermann, Edward Mckenzie, Rebecca Jeffery, Kevin Couper, Stamatia Papoutsopoulou, Axel Roers, Werner Muller

Center for Translational Medicine Faculty Papers

Interleukin-10 (IL-10) is an immunoregulatory cytokine that plays a pivotal role in modulating inflammation. IL-10 has inhibitory effects on proinflammatory cytokine production and function in vitro and in vivo; as such, IL-10 is viewed as a potential treatment for various inflammatory diseases. However, a significant drawback of using IL-10 in clinical application is the fact that the biologically active form of IL-10 is an unstable homodimer, which has a short half-life and is easily degraded in vivo. Consequently, IL-10 therapy using recombinant native IL-10 has had only limited success in the treatment of human disease. To improve the therapeutic potential …

Heat Shock Protein 90 (Hsp90)-Inhibitor-Luminespib-Loaded-Protein-Based Nanoformulation For Cancer Therapy, Ankit K. Rochani, Sivakumar Balasubramanian, Aswathy Ravindran Girija, Toru Maekawa, Gagan Kaushal, Phd, D Sakthi Kumar

College of Pharmacy Faculty Papers

Drugs targeting heat shock protein 90 (Hsp90) have been extensively explored for their anticancer potential in advanced clinical trials. Nanoformulations have been an important drug delivery platform for the anticancer molecules like Hsp90 inhibitors. It has been reported that bovine serum albumin (BSA) nanoparticles (NPs) serve as carriers for anticancer drugs, which have been extensively explored for their therapeutic efficacy against cancers. Luminespib (also known as NVP-AUY922) is a new generation Hsp90 inhibitor that was introduced recently. It is one of the most studied Hsp90 inhibitors for a variety of cancers in Phase I and II clinical trials and is …

Fatal Case Of Newborn Lassa Fever Virus Infection Mimicking Late Onset Neonatal Sepsis: A Case Report From Northern Nigeria, Taofik Oluwaseun Ogunkunle, Surajudeen Oyeleke Bello, Chinwe Immaculata Anderson, Rashida Musa, Rasaq Olaosebikan, Abdulazeez Imam

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Lassa fever is a zoonotic viral infection endemic to the West Africa countries. It is highly fatal during pregnancy and as such reports of neonatal onset Lassa fever infections are rare in scientific literature. We report a fatal case of Lassa fever in a 26-day-old neonate mimicking the diagnosis of late-onset neonatal sepsis.

CASE PRESENTATION: The patient is a 26-day-old neonate who was admitted with a day history of fever, poor feeding, pre-auricular lymphadenopathy and sudden parental death. He was initially evaluated for late onset neonatal sepsis. He later developed abnormal bleeding and multiple convulsions while on admission, prompting …

Initial Experience Using 3-Dimensional Printed Models For Head And Neck Reconstruction In Haiti., Swar Vimawala, Terry Gao, Jared Goldfarb, Dominick Gadaleta, Bon Ku, Patrick Jean-Gilles, Adam Luginbuhl, Robert Pugliese, Donald Weed, Joseph M Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

This report describes the first use of a novel workflow for in-house computer-aided design (CAD) for application in a resource-limited surgical outreach setting. Preoperative computed tomography imaging obtained locally in Haiti was used to produce rapid-prototyped 3-dimensional (3D) mandibular models for 2 patients with large ameloblastomas. Models were used for patient consent, surgical education, and surgical planning. Computer-aided design and 3D models have the potential to significantly aid the process of complex surgery in the outreach setting by aiding in surgical consent and education, in addition to expected surgical applications of improved anatomic reconstruction.

Efficient Non-Epigenetic Activation Of Hiv Latency Through The T-Cell Receptor Signalosome., Joseph Hokello, Adhikarimayum Lakhikumar Sharma, Mudit Tyagi

Center for Translational Medicine Faculty Papers

Human immunodeficiency virus type-1 (HIV-1) can either undergo a lytic pathway to cause productive systemic infections or enter a latent state in which the integrated provirus remains transcriptionally silent for decades. The ability to latently infect T-cells enables HIV-1 to establish persistent infections in resting memory CD4+ T-lymphocytes which become reactivated following the disruption or cessation of intensive drug therapy. The maintenance of viral latency occurs through epigenetic and non-epigenetic mechanisms. Epigenetic mechanisms of HIV latency regulation involve the deacetylation and methylation of histone proteins within nucleosome 1 (nuc-1) at the viral long terminal repeats (LTR) such that the inhibition …

Contemporary Interventional Radiology Employment: Analysis Of The American College Of Radiology And The Society Of Interventional Radiology Occupational Portals, Anthony N Hage, Vibhor Wadhwa, Eric J Monroe, David S Shin, Jeffrey Forris Beecham Chick

Department of Radiology Faculty Papers

No abstract provided.

Mg2+-Dependent Methyl Transfer By A Knotted Protein: A Molecular Dynamics Simulation And Quantum Mechanics Study, Agata P Perlinska, Marcin Kalek, Thomas Christian, Ya-Ming Hou, Joanna I Sulkowska

Department of Biochemistry and Molecular Biology Faculty Papers

Mg2+ is required for the catalytic activity of TrmD, a bacteria-specific methyltransferase that is made up of a protein topological knot-fold, to synthesize methylated m1G37-tRNA to support life. However, neither the location of Mg2+ in the structure of TrmD nor its role in the catalytic mechanism is known. Using molecular dynamics (MD) simulations, we identify a plausible Mg2+ binding pocket within the active site of the enzyme, wherein the ion is coordinated by two aspartates and a glutamate. In this position, Mg2+ additionally interacts with the carboxylate of a methyl donor cofactor S-adenosylmethionine (SAM). The computational results are validated by …

Recent Advances In The Management Of Gastrointestinal Stromal Tumor., Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Gastrointestinal stromal tumor (GIST) is a rare but an important clinical entity seen in our clinical practice. It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine. Although the exact prevalence of GIST is not known, the incidence of GIST has been increasing. GISTs arise from interstitial cells of Cajal. Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene. 15% of GISTs do not have these mutations and they are called wild-type GISTs. Almost all GISTs express KIT receptor tyrosine kinase. …

Depression In Primary Care: With A Focus On First-Line Medications, Michael Danielewicz, Md

Department of Family & Community Medicine Presentations and Grand Rounds

This Lecture Will Cover:

• An overview of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), bupropion and mirtazapine
• Appropriate selection and dose adjustments of first-line agents for depressive disorders in a primary care setting
• Monitoring and tapering first-line antidepressants
• Special considerations in treatment
• Future directions for antidepressant treatment

Hepatic Stellate Cells And Hepatocarcinogenesis, Anna E Barry, Rajkumar Baldeosingh, Ryan Lamm, Keyur Patel, Kai Zhang, Dana A Dominguez, Kayla J Kirton, Ashesh P. Shah, Hien Dang

Department of Surgery Faculty Papers

Hepatic stellate cells (HSCs) are a significant component of the hepatocellular carcinoma (HCC) tumor microenvironment (TME). Activated HSCs transform into myofibroblast-like cells to promote fibrosis in response to liver injury or chronic inflammation, leading to cirrhosis and HCC. The hepatic TME is comprised of cellular components, including activated HSCs, tumor-associated macrophages, endothelial cells, immune cells, and non-cellular components, such as growth factors, proteolytic enzymes and their inhibitors, and other extracellular matrix (ECM) proteins. Interactions between HCC cells and their microenvironment have become topics under active investigation. These interactions within the hepatic TME have the potential to drive carcinogenesis and create …

Menopause In Brazilian Women With Sickle Cell Anemia With And Without Hydroxyurea Therapy., Ana Mach Queiroz, Clarisse Lopes De Castro Lobo, Samir K. Ballas

Cardeza Foundation for Hematologic Research

Women with sickle cell anemia (SCA) require special attention for myriad obstetric and gynecologic issues associated with this complex hematologic disorder. These affect all aspects of female life from menarche through menopause. Information regarding obstetric and gynecologic complications of sickle cell disease (SCD), with a few exceptions, is based primarily on observational, anecdotal, retrospective, or cohort studies that may not reflect current aspects of obstetric care.¹ Similarly, there are no recent reports about menopause (also known as climacteric) in women with SCA. The fact that life expectancy of women with SCA was determined to be 46–48 years² delayed …

Hearing Loss In Mucopolysaccharidoses: Current Knowledge And Future Directions., Jeremy Wolfberg, Keerthana Chintalapati, Shunji Tomatsu, Kyoko Nagao

Department of Pediatrics Faculty Papers

Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders caused by a deficiency of one of the enzymes involved in the degradation of glycosaminoglycans. Hearing loss is a common clinical presentation in MPS. This paper reviews the literature on hearing loss for each of the seven recognized subtypes of MPS. Hearing loss was found to be common in MPS I, II, III, IVA, VI, and VII, and absent from MPS IVB and MPS IX. MPS VI presents primarily with conductive hearing loss, while the other subtypes (MPS I, MPS II, MPS III, MPS IVA, and MPS VII) can present with …

A Surgeon's Handedness In Direct Anterior Approach-Hip Replacement., Xiangpeng Kong, Minzhi Yang, Alvin Ong, Renwen Guo, Jiying Chen, Yan Wang, Wei Chai

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The impact of handedness on clinical outcomes was easily overlooked in hip replacement. This study aimed to find whether the component positioning and hip function were affected by the handedness in total hip arthroplasty (THA) through direct anterior approach (DAA).

METHODS: Total 102 patients who underwent bilateral DAA-THAs simultaneously between May 2016 and November 2018 in our institute were reviewed. All surgeries were operated by one right-handed surgeon. Their demographic, cup positioning, stem alignment, femoral stem fit, Harris hip score (HHS), intraoperative and postoperative complications were used to evaluate the role of handedness in DAA.

RESULTS: The inclination of …

Bringing Function To Families: Ot’S Role In Parenting With Sci, Alexandra Economou, Ots, Molly Flannery, Ots, Nikki Tutelman, Ots, Courtney Wagner, Ots, Rebecca Sinko, Otd, Otr/L

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives:

• Describe participation challenges that impact the role of parenting for parents with SCI
• Identify evidence-based intervention areas within the scope of OT that facilitate participation in the role of parenting with SCI
• Discuss the unique need and application for OT services to support parents with SCI

PICO Question:

What are interventions within the scope of OT practice that increase participation in the role of parenting with spinal cord injury (SCI)?

Current Practices, Perceptions And Challenges Of Telehealth In The Treatment Of Mental Health In The U.S. Department Of Veterans Affairs, James E. Plummer

Full-Text Theses & Dissertations

Currently there are 17,964,242 million Veterans living in the U.S. Around 50% of these Veterans are over 65 years of age. Many U.S. service members – both active and retired, experience trauma and dysfunction in restructuring their lives. Mental health problems are reported in over 50% of Veterans both in active service and retired. According to the U.S. Department of Veterans Affairs (VA), ten times more suicides are reported among Veterans who did not register with the VA compared to those who do register. Longer deployments, shorter times at home between the deployments and combat exposure are the greatest contributors …

Promoting Coping For Adults With Neurodegenerative Conditions, Julia Kraushaar, Ots, Melanie Watt, Ots, Kristine Ismael, Ots, Julia Snavely, Ots, Adel Herge, Otd, Otr/L, Faota

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives

• Identify neurodegenerative conditions and how they impact occupational performance and quality of life (QoL)
• Describe the effects of coping skill interventions on QoL among adults with neurodegenerative conditions
• Examine the role of occupational therapy in improving QoL in adults with neurodegenerative conditions

PICO Question

Within the scope of occupational therapy, what are the effects of coping skills interventions on improving quality of life in adults with neurodegenerative conditions?

Promoting Independence: Empowering Successful Transitions Out Of The North American Foster Care System, Samantha Chong, Ots, Kevin Dang, Ots, Leondra Graves, Ots, Taylor Holt, Ots, Rebecca Sinko, Otd, Otr/L

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives

• Identify the supports and barriers of youth transitioning out of the North American foster care/foster home care systems.
• Describe occupational therapy’s current and emerging roles in life skills/IADL training with youth transitioning out of the foster care system.
• Describe the positive outcomes related to successful transitions into adulthood for foster youth.

PICO Question:

What life skills training interventions conducted by occupational therapy practitioners improve independence for youth transitioning out of the foster care system?

Empower The Future: The Impact Of Family-Centered Interventions On School Success For Children From Low Socioeconomic Backgrounds, Jacqueline Bruce, Ots, Ornella Delle Noci, Ots, Amaris Dobson, Ots, Bryan Johnston, Ots, Rebecca Sinko, Otd, Otr/L

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives

• Describe poverty’s impact on early childhood development and subsequent effects on school participation.

• Discuss evidence-based, family-centered interventions associated with increased school success for children from low-income communities.

• .Acquire the knowledge to apply effective interventions within the scope of occupational therapy practice to promote improved school success.

PICO Question:

What is the impact of family-centered occupational therapy interventions on future school participation for children (0-6 years old) from low socioeconomic backgrounds?

Gaining Momentum: A Systematic Review Of Interventions To Promote Mental Health & Wellness For Mothers Postpartum, Amanda Marcinko, Ots, Lauren Opdyke, Ots, Jessica Sinotte, Ots, Emily Van’T Slot, Ots, E. Adel Herge, Otd, Otr/L, Faota

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Outcomes:

• Define participation challenges of mothers in the postpartum period.
• Discuss qualities of effective interventions within maternal mental healthcare.
• Apply effective interventions in occupational therapy practice to promote mental health and wellness of postpartum mothers.

PICO Question:

What interventions within the scope of occupational therapy practice promote mental health and wellness for women in the postpartum period?