Medicine and Health Sciences Commons^™

Mutational Load May Predict Risk Of Progression In Patients With Barrett's Oesophagus And Indefinite For Dysplasia: A Pilot Study, A. J. Trindade, M. J. Mckinley, M. Alshelleh, G. Levi, M. Stewart, K. J. Quinn, R. M. Thomas

Journal Articles

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Background and aims Mutational load (ML) has been shown to help risk-stratify those that may progress from non-dysplastic Barrett's oesophagus (BE) to dysplastic disease. Management of patients with BE and indefinite for dysplasia (BE-IND) is challenging and risk stratification tools are lacking. The aim of this pilot study is to evaluate the utility of ML for risk stratification in patients with BE-IND. Methods This is a single-centre, retrospective pilot study evaluating ML quantification in patients with BE-IND. Histology at …

Pooled Analysis Of The Efficacy And Safety Of Video Capsule Endoscopy In Patients With Implantable Cardiac Devices, R. Tabet, N. Nassani, B. Karam, Y. Shammaa, P. Akhrass, L. Deeb

Journal Articles

© 2019 Rabih Tabet et al. Background. To date, video capsule endoscopy (VCE) is still contraindicated by the FDA and the main manufacturers of Cardiac Implantable Electronic Devices (CIED) in patients with CIED, given a theoretical electromagnetic interference and possible device malfunction. Objectives. The objective of this study was to assess the safety profile and efficacy of VCE in patients with implantable cardiac devices through analyzing the risk of mutual interference. Methods. A systematic review of PubMed, Web of Science, and Embase databases was conducted. Peer-reviewed original articles, published in the English language and containing "capsule endoscopy" AND "pacemaker", "defibrillator" …

Small Septal Branch Artery Thrombus Inducing Ventricular Fibrillation: To Intervene Or Not To Intervene, V. Agarwal, P. C. Olson, J. Mroue, Y. Olkovsky, S. Bekheit, J. Lafferty

Journal Articles

© The Author(s) 2019. A 64-year-old woman presented for chest pain and was diagnosed with anteroseptal ST segment elevation myocardial infarction (STEMI). Emergent angiography showed 95% stenosis at the ostium of the second septal branch, consistent with thrombus, and no other significant lesions. The lesion was not amenable to intervention due to small caliber. Post angiography, the patient’s electrical rhythm deteriorated into ventricular fibrillation. Following resuscitation, repeat angiography confirmed same findings. Electrophysiology study at 3 months was positive for inducing fibrillation. Due to patient risk factors, she had placement of a dual chamber defibrillator. A 5-month follow-up echocardiogram showed a …

Acute Esophageal Necrosis: A View In The Dark, H. Khan, M. Ahmed, M. Daoud, J. Philipose, S. Ahmed, L. Deeb

Journal Articles

© 2019 The Author(s). Published by S. Karger AG, Basel. Acute esophageal necrosis (AEN), also known as Gurvits syndrome, black esophagus, or acute necrotizing esophagitis, is a rare clinical entity and an unusual reason for upper gastrointestinal bleeding. It is typically described in critically ill patients with multiple medical conditions, arising from a combination of ischemic insult to the esophageal mucosa due to low-flow vascular states, corrosive injury caused by reflux of acid and pepsin, and decreased function of the mucosal barrier systems and reparative mechanisms as occurs in malnourished and debilitated physical states. Patients with AEN tend to be …

A Rare Case Of Hiv-Induced Inflammatory Demyelinating Polyneuropathy., A. Sajan, S. Zahid, J. Stumph, D. Griepp, S. Saba, N. Ilyas, I. M. Mc Farlane

Journal Articles

Background:Acute inflammatory demyelinating polyneuropathy (AIDP) is an uncommon form of neuropathy in HIV-infected patients that can cause pain, sensory disturbance, and motor weakness. Case presentation:A 23-year-old African American male with past medical history of Guillain-Barre Syndrome (GBS), Lyme disease, and sexually transmitted infections including syphilis and chlamydia presented with acute back pain radiating to bilateral lower extremities with worsening right foot weakness for four days. Cerebrospinal fluid (CSF) studies including meningoencephalitis panel were negative as well as blood tests for Lyme disease and HIV antibody testing. Patient was initially treated with penicillin for positive treponemal serology but without improvement in …

Direct Oral Anticoagulants In Cirrhotic Patients: Current Evidence And Clinical Observations, S. Elhosseiny, H. Al Moussawi, J. M. Chalhoub, J. Lafferty, L. Deeb

Journal Articles

© 2019 Sherif Elhosseiny et al. The introduction of Direct Oral Anticoagulants (DOACs) to the pharmaceutical market provided patients and clinicians with novel convenient and safe options of anticoagulation. The use of this class of medications is currently limited to venous thromboembolic therapy and prophylaxis, in addition to stroke prophylaxis in patients with nonvalvular atrial fibrillation. Despite their altered hemostasis, patients with cirrhosis are thought to be in a procoagulant state and thus prone to thrombus formation. Patients with cirrhosis might benefit from the convenience of DOACs; however, the medical literature includes limited data on the efficacy and safety of …

Radiation Recall Pneumonitis In The Setting Of Immunotherapy And Radiation: A Focused Review, K. Mcgovern, M. Ghaly, M. Esposito, K. Barnaby, N. Seetharamu

Journal Articles

© 2019 Nagashree Seetharamu. Radiation recall pneumonitis (RRP) is an entity described as pneumonitis localized to a previously irradiated field after exposure to a systemic agent. It has previously been described in the literature in the context of chemotherapeutic agents as well as certain biologics. With immunotherapy taking a more prominent role in the treatment of several different malignancies and its own baseline risk of pneumonitis, it is important to explore the likelihood of RRP, specifically in those patients who have been previously treated with radiation therapy. The current literature regarding RRP with checkpoint inhibitors is reviewed in this article. …

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Triggered By Emotional Stress, C. A. Obi, E. Thompson, L. Mordukhaev, I. Khan, N. J. Zhang

Journal Articles

© 2019, Copyright © 2019 Baylor University Medical Center. A 22-year-old woman presented with disorganized behaviors, restlessness, and subacute decline in mental status in the setting of stress. Extensive workup for autoimmune diseases disclosed positive anti-N-methyl-d-aspartate (NMDA) receptor antibodies. We recommend that fertility preservation should be discussed and stress management should be considered in patients with a history of anti-NMDA autoimmune encephalitis because this can help in preventing relapse.

A 30-Year-Old Carrier Of Gaucher Disease With Multiple Myeloma., J. Chadha, T. Sahai, J. Schwimmer, D. Shani

Journal Articles

We are reporting a case of a 30-year-old male with no past medical history who presented with new onset of renal failure, anemia, and splenomegaly and was diagnosed with multiple myeloma. Given the splenomegaly and the patient's Jewish heritage, blood tests were done and the patient was found to be a Gaucher disease carrier. The association of Gaucher disease and multiple myeloma has previously been reported; however, we want to describe the case of a young Gaucher disease carrier who developed multiple myeloma and provide a review of the literature.

Septic Emboli Of The Lung Due To Fusobacterium Necrophorum, A Case Of Lemierre's Syndrome, S. Habib, K. Rajdev, A. H. Siddiqui, M. Azam, A. Memon, M. Chalhoub

Journal Articles

© 2019 The Authors Fusobacterium necrophorum plays a causal role in a rare and life-threatening condition, Lemierre's syndrome. It is characterized by infection involving the posterior compartment of the lateral pharyngeal space complicated by septic suppurative thrombophlebitis of the internal jugular vein with F. necrophorum bacteremia and metastatic abscesses, primarily to the lung and pulmonary septic emboli. Herein, we present a very rare case of oropharyngeal infection complicated by Lemierre's syndrome with characteristic septic emboli to the lungs presenting as sore throat in a previously healthy patient. A 23-year-old woman presented with sore throat and was found to be in …

Placental Transmogrification Of The Lung Associated With Unilateral Pleural Effusion: A Case Report With A Comprehensive Review Of The Literature, N. Narula, S. Ngu, D. Sharma, F. Siddiqui, M. Chalhoub

Journal Articles

© 2018 The Authors Placental transmogrification of the lung (PTL) is a rare benign pulmonary lesion resembling chorionic villi. With fewer than 40 cases reported in literature, associations have thus far been made with bullous emphysema, pulmonary fibrochondromatous hamartomas and adenocarcinoma of the lung. Typically presenting as unilateral solitary cystic or bullous lesion, we report the first case of PTL presenting with unilateral pleural effusion. A 70-year-old male presented with recurrent unilateral pleural effusion that failed to resolve with multiple thoracenteses. He underwent thoracoscopic excision and biopsy of a cystic mass identified on computed tomography (CT) scan which revealed characteristic …

Combination Therapy With Trimethoprim-Sulfamethoxazole And Caspofungin In A Case Of Severe Pneumocystis Pneumonia, R. Koshy, T. Chen

Journal Articles

© 2019 The Authors Trimethoprim-sulfamethoxazole (TMP-SMX, co-trimoxazole, or bactrim) has been the standard first-line treatment against Pneumocystis jirovecii pneumonia (PCP) for decades. However, adverse effects and cases of treatment failure have led to a search for alternative agents. We present a case of a 50 year old immune compromised female whose course of PCP did not improve until Caspofungin was added to TMP-SMX.

Monoclonal Antibody Targeting Bdca2 Ameliorates Skin Lesions In Systemic Lupus Erythematosus, R. Furie, V. P. Werth, J. F. Merola, L. Stevenson, T. L. Reynolds, H. Naik, W. Wang, R. Christmann, A. Gardet, N. Franchimont, +6 Additional Authors

Journal Articles

No abstract provided.

Quantifying Patient Satisfaction With Process Metrics Using A Weighted Bundle Approach., N. B. Riebling, S. Norouzzadeh, G. Reeder, C. Mouradian, A. Hillier, R. Cowan, M. Doerfler

Journal Articles

Background:Current patient satisfaction assessment results are delayed and obtained from select patient surveys. As a result, these assessments may not represent the experience of the entire patient population. This study developed a method to measure and evaluate all patients' experiences while they are within the care episode and link it to processes within the organisation. Methods:Using the Six Sigma methodology, sites assembled diverse teams to categorise and analyse negative experience comments from patients to understand the drivers of dissatisfaction. These customer expectations lead to the development of the four components in the Patient Experience Bundle (PEB): communication, environment, basic needs/comfort …

Medical Education Using Minimal Technology: Achieving Professional Development, K. A. Friedman, S. W. Herman, A. Fornari

Journal Articles

No abstract provided.

Hepatocellular Carcinoma After Successful Treatment Of Hepatitis C Virus With Ledipasvir/Sofosbuvir Presenting As Acute Pulmonary Tumor Embolism., S. Habib, M. Azam, A. H. Siddiqui, K. Rajdev, M. Chalhoub

Journal Articles

Hepatitis C virus (HCV)-induced cirrhosis is a major cause of hepatocellular carcinoma (HCC) worldwide. HCC is an aggressive malignancy in which tumor thrombus can invade portal vein, hepatic veins and inferior vena cava (IVC) in the later stages. Our case brings to attention, HCV patient population who might need long-term follow-up to ensure HCV clearance. Physicians should ensure appropriate follow-up after treatment of HCV and should emphasize on the ongoing screening for HCC in patients with cirrhosis or advanced fibrosis, regardless of antiviral treatment outcome.

Resistin And Adenylyl Cyclase-Associated Protein 1 (Cap1) Regulate The Expression Of Genes Related To Insulin Resistance In Bnl Cl.2 Mouse Liver Cells, D. Avtanski, K. Chen, L. Poretsky

Journal Articles

© 2019 The Author(s) Resistin is an adipokine produced in white adipose tissue that is thought to modulate insulin sensitivity in peripheral tissues (such as liver, skeletal muscle or adipose tissue). Human and murine resistin molecules share only about 60% sequence homology. [1] Contrary to humans, in which resistin is secreted mostly by macrophages, Park and Ahima 2013 resistin in rodents is produced primarily by the mature adipocytes of the white adipose tissue. Although resistin can bind to toll-like receptor 4 (TLF4) activating proinflammatory responses in human and rodents, [3–8] the inflammatory actions of resistin in human monocytes were found …

A Novel Curriculum To Prepare Internal Medicine Residents For Fellowship Interviews., M. Sinclair, J. Raimo, K. Wong, M. Kline, K. Friedman

Journal Articles

Background:Applications to the Fellowship Match through the National Resident Matching Program (NRMP) Specialties Matching Service (SMS) are at an all-time high. Data regarding the preparedness of medical residents who go through the interview process is limited. Objective:To assess whether the implementation of an interview curriculum could improve medical resident preparedness for and performance during fellowship interviews. Methods:All third-year internal medicine residents (N = 18) at the Zucker School of Medicine at Hofstra/Northwell (Northwell) applying to subspecialty fellowship participated in an interview curriculum that comprised a didactic session and an Objective Structured Teaching Exercise (OSTE). Participants were surveyed on preparedness before …

Live Usability Testing Of Two Complex Clinical Decision Support Tools: Observational Study, S. Richardson, D. Feldstein, T. Mcginn, L. S. Park, S. Khan, R. Hess, P. D. Smith, R. G. Mishuris, L. Mccullagh, D. Mann

Journal Articles

© 2019 Journal of Medical Internet Research. All rights reserved. Background: Potential of the electronic health records (EHR) and clinical decision support (CDS) systems to improve the practice of medicine has been tempered by poor design and the resulting burden they place on providers. CDS is rarely tested in the real clinical environment. As a result, many tools are hard to use, placing strain on providers and resulting in low adoption rates. The existing CDS usability literature relies primarily on expert opinion and provider feedback via survey. This is the first study to evaluate CDS usability and the provider-computer-patient interaction …

Adult Onset Morgagni Hernia: Medical Vs. Surgical Management., A. Elfiky, D. Daneshvar, M. Krzyzak, I. Mukherjee

Journal Articles

Morgagni hernia is a type of diaphragmatic hernia where bowel content herniates through an irregular opening into the thoracic cavity. Herein, we present the case of an 84-year-old female patient with multiple hospital admissions for abdominal symptoms. Radiological studies confirmed Morgagni hernia. She underwent a laparoscopic intervention with mesh placement. She was discharged in stable condition and was doing well on follow-up.

Changes In Pulmonary Artery Pressure Before And After Left Ventricular Assist Device Implantation In Patients Utilizing Remote Haemodynamic Monitoring, A. Kilic, J. N. Katz, S. M. Joseph, M. A. Brisco-Bacik, N. Uriel, B. Lima, R. Agarwal, R. Bharmi, D. J. Farrar, S. Lee

Journal Articles

No abstract provided.

Current Aats Guidelines On Surgical Treatment Of Infective Endocarditis, G. B. Pettersson, S. T. Hussain

Journal Articles

© Annals of Cardiothoracic Surgery. The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decision-making related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, …

Necrotizing Infection Of The Aortic Arch: Reconstruction Utilizing Unusual Extra-Anatomic Bypass Grafts To Reroute Cerebral Blood Flow., J. M. Hemli, B. D. Patton, S. J. Scheinerman, D. R. Brinster

Journal Articles

Destructive infections of the aortic arch and great vessels are challenging to manage. We describe a novel technique for debranching the right cerebral and upper extremity arteries via composite extra-anatomic bypasses from the femoral artery, with subsequent homograft in-line reconstruction of the arch, in a patient with Staphylococcus sepsis and necrosis of the arch and great vessels.

Breadth And Depth Of Working Memory And Executive Function Compromises In Mild Cognitive Impairment And Their Relationships To Frontal Lobe Morphometry And Functional Competence, L. Garcia-Alvarez, J. J. Gomar, A. Sousa, M. P. Garcia-Portilla, T. E. Goldberg

Journal Articles

© 2019 Introduction: The extent of working memory (WM) and executive function (EF) impairment in mild cognitive impairment (MCI) is not well-characterized. Methods: We compared 48 patients with MCI, 124 noncognitively impaired elderly healthy controls, and 57 patients with Alzheimer's disease (AD) on multiple WM/EF measures, frontal lobe integrity indexes, and functioning. Results: Patients with MCI demonstrated worse performance on nearly all WM/EF tests. This profile of impairment was refined in a factor analysis that identified three primary WM/EF constructs: WM storage; speed and controlled visual search; and manipulation of information and problem solving. EF impairments were associated with reductions …

Internet Searches For Medical Symptoms Before Seeking Information On 12-Step Addiction Treatment Programs: A Web-Search Log Analysis, G. Nitzburg, I. Weber, E. Yom-Tov

Journal Articles

© 2019 George Nitzburg, Ingmar Weber, Elad Yom-Tov. Background: Brief intervention is a critical method for identifying patients with problematic substance use in primary care settings and for motivating them to consider treatment options. However, despite considerable evidence of delay discounting in patients with substance use disorders, most brief advice by physicians focuses on the long-term negative medical consequences, which may not be the best way to motivate patients to seek treatment information. Objective: Identification of the specific symptoms that most motivate individuals to seek treatment information may offer insights for further improving brief interventions. To this end, we used …

Objective User Engagement With Mental Health Apps: Systematic Search And Panel-Based Usage Analysis., A. Baumel, F. Muench, S. Edan, J. Kane

Journal Articles

BACKGROUND: Understanding patterns of real-world usage of mental health apps is key to maximizing their potential to increase public self-management of care. Although developer-led studies have published results on the use of mental health apps in real-world settings, no study yet has systematically examined usage patterns of a large sample of mental health apps relying on independently collected data.

OBJECTIVE: Our aim is to present real-world objective data on user engagement with popular mental health apps.

METHODS: A systematic engine search was conducted using Google Play to identify Android apps with 10,000 installs or more targeting anxiety, depression, or emotional …

Quality Of Life Outcomes Following Organ-Sparing Sbrt In Previously Irradiated Recurrent Head And Neck Cancer, E. Gogineni, I. Zhang, Z. Rana, M. Marrero, G. Gill, A. Sharma, A. C. Riegel, S. Teckie, M. Ghaly

Journal Articles

No abstract provided.

Assessing Cognitive Impairment In Sle: Examining Relationships Between Resting Glucose Metabolism And Anti-Nmdar Antibodies With Navigational Performance., E. Ploran, C. Tang, M. Mackay, E. Anderson, C. Aranow, C. Sartori, P. Watson, B. Volpe, B. Diamond, D. Eidelberg, +4 Additional Authors

Journal Articles

Objective: Resting Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) brain imaging and neuropsychological testing were used to investigate the usefulness of a spatial navigation task (SNT) as a performance benchmark for cognitive impairment related to anti-N-methyl D-aspartate (anti-NMDA) receptor antibodies (DNRAb) in SLE.

Methods: Neuropsychological assessments, including a desktop 3-D virtual SNT, were performed on 19 SLE participants and 9 healthy control (HC) subjects. SLE participants had stable disease activity and medication doses and no history of neuropsychiatric illness or current use of mind-altering medications. Resting FDG-PET scans were obtained on all SLE participants and compared with a historical set from …

Cold-Inducible Rna-Binding Protein Induces Neutrophil Extracellular Traps In The Lungs During Sepsis, Y. Ode, M. Aziz, H. Jin, A. Arif, J. G. Nicastro, P. Wang

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No abstract provided.

Extracellular Cold Inducible Rna-Binding Protein Mediates Binge Alcohol-Induced Brain Hypoactivity And Impaired Cognition In Mice, A. Jacob, Y. Ma, E. Nasiri, M. Ochani, J. Carrion, S. Peng, M. Brenner, P. T. Huerta, P. Wang

Journal Articles

No abstract provided.