Medicine and Health Sciences Commons^™

Understanding Hyperparathyroidism In Renal Disease, Rosemary Nwoko, Md, Kara Chenitz, Md

The Medicine Forum

The parathyroid glands are four pea-sized glands located onthe four corners of the thyroid gland. They secrete parathyroidhormone (PTH), which maintains calcium and phosphorushomeostasis. PTH regulates calcium such that when serumlevels of calcium fall too low, it increases the serum calciumlevel by stimulating more calcium release from the bones,increasing intestinal absorption of calcium and decreasingcalcium excretion into the urine. When the serum calciumnormalizes, the parathyroid gland shuts off the production ofPTH. An excess of PTH in the system throws off the calciumphosphorushomeostatic balance, resulting in various symptomsand clinical effects.

Congestive Heart Failure And Vitamin D Deficiency, Ankitkumar K. Patel, Md, Mph, Matthew Decaro, Md, Paul J. Mather, Md

The Medicine Forum

Introduction

Congestive heart failure (CHF) is a chronic medical condition whoseincidence is rising. The prevalence of CHF is approximately 1% to3% in Western countries. Despite innovations in medical therapy,CHF is associated with high morbidity and mortality rates.

CHF patients commonly experience muscle weakness and fatigueas two major symptoms. An altered intracellular handling ofionized calcium has been suggested to play a vital role in impairedmyocardial contraction. In isolated myocytes from patientswith end stage heart failure, systolic ionized calcium levelswere markedly decreased, while diastolic levels were elevated ascompared to healthy controls. In addition, digitalis and betablockermedical therapy is frequently used in CHF …

Table Of Contents, The Medicine Forum, Volume 10, 2008

The Medicine Forum

Table of Contents, The Medicine Forum, Volume 10, 2008

From The Editors, Tamara Solitro, Md, Anthony Lanfranco, Md, Ankitkumar Patel, Md, Anastasia Shnitser, Md, Andrew Foy, Md, Claire Raab, Md, Tina Shah, Md

The Medicine Forum

Argentina, California, Kenya, Alaska — these are just a fewof the places visited by our internal medicine residents andcaptured in breathtaking photographs that are exhibitedthroughout this issue of The Jefferson Medicine Forum. It iseasy to appreciate the beauty of nature when taking in thesepictures of stunning aerial views and colorful landscapes.Their display in this journal is fitting amongst the academicarticles that speak to the intellectual curiosity of our residentsand the diversity of pathology seen at Thomas JeffersonUniversity Hospital.

From The Desk Of The Residency Program Director, Gregory C. Kane Md, Facp, Fccp

The Medicine Forum

To Friends of the Department of Medicine:

Earlier this academic year, The Institute of Medicine(IOM) issued their most recent report, “Resident DutyHours: Enhancing Sleep, Supervision, and Safety,” whichrecommends changes to medical residents’ duty hours andworkloads to “promote conditions for safe medical care,improve the education of doctors in training, and increasethe safety of residents and the general public.” While theIOM simply makes recommendations, the AccreditationCouncil for Graduate Medical Education (ACGME) makesthe actual rules that a residency program must follow inorder to maintain accreditation. Under the leadership ofthe ACGME, one of the Residency Review Committees(RRC) establishes these accreditation guidelines for internalmedicine residency …

Modeling Techniques For The High-Resolution Interpretation Of Cryo-Electron Microscopy Reconstructions, Mirabela Rusu

Dissertations and Theses (Open Access)

Essential biological processes are governed by organized, dynamic interactions between multiple biomolecular systems. Complexes are thus formed to enable the biological function and get dissembled as the process is completed. Examples of such processes include the translation of the messenger RNA into protein by the ribosome, the folding of proteins by chaperonins or the entry of viruses in host cells. Understanding these fundamental processes by characterizing the molecular mechanisms that enable then, would allow the (better) design of therapies and drugs. Such molecular mechanisms may be revealed trough the structural elucidation of the biomolecular assemblies at the core of these …

Sr-A Ligand And M-Csf Dynamically Regulate Sr-A Expression And Function In Primary Macrophages Via P38 Mapk Activation, Dejan Nikolic, Lindsay Calderon, Liqin Du, Steven R. Post

Pharmacology and Nutritional Sciences Faculty Publications

BACKGROUND: Inflammation is characterized by dynamic changes in the expression of cytokines, such as M-CSF, and modifications of lipids and proteins that result in the formation of ligands for Class A Scavenger Receptors (SR-A). These changes are associated with altered SR-A expression in macrophages; however, the intracellular signal pathways involved and the extent to which SR-A ligands regulate SR-A expression are not well defined. To address these questions, SR-A expression and function were examined in resident mouse peritoneal macrophages incubated with M-CSF or the selective SR-A ligand acetylated-LDL (AcLDL).

RESULTS: M-CSF increased SR-A expression and function, and required the specific …

Visual Attention And Social Anxiety: Oculomotor Behavior When Threatened, Jacqueline S. Singh

Department of Psychology: Dissertations, Theses, and Student Research

A growing theoretical and research literature suggests that trait and state social anxiety can predict attentional patterns in the presence of emotional stimuli. The current study addressed some inconsistencies and gaps in the literature using eye tracking methodology. Participants with high and low trait social anxiety were randomly assigned to either give a speech or to watch a video of another individual delivering a speech (state social anxiety manipulation). Next, participants were asked to engage in a free view task in which pairs of emotional facial stimuli (angry-happy, angry-neutral, or happy-neutral) were presented for 3 s. Eye movements were monitored …

The Hirsch Index - A Play On Numbers Or A True Appraisal Of Academic Output?, Taimur Saleem

Medical College Documents

Citation metrics have rapidly gained importance in today's landscape and are being increasingly utilized as a yardstick in making several important decisions regarding academic funding and appointments. The impact factor has traditionally been the metric most often employed in this regard. However, the emergence of the Hirsch index has provided an alternative to the impact factor. The h-index, despite its flaws, continues to gain acceptance and popularity in the medical community. Several medical journals have evaluated and endorsed the use of the h-index. However, it must be interpreted with all of its limitations in mind.

Oncogene-Induced Nrf2 Transcription Promotes Ros Detoxification And Tumorigenesis., Gina M. Denicola, Florian A. Karreth, Timothy J. Humpton, Aarthi Gopinathan, Cong Wei, Kristopher Frese, Dipti Mangal, Kenneth H. Yu, Charles J. Yeo, Eric S. Calhoun, Francesca Scrimieri, Jordan M. Winter, Ralph H. Hruban, Christine Iacobuzio-Donahue, Scott E. Kern, Ian A Blair, David A. Tuveson

Department of Surgery Faculty Papers

Reactive oxygen species (ROS) are mutagenic and may thereby promote cancer. Normally, ROS levels are tightly controlled by an inducible antioxidant program that responds to cellular stressors and is predominantly regulated by the transcription factor Nrf2 (also known as Nfe2l2) and its repressor protein Keap1 (refs 2-5). In contrast to the acute physiological regulation of Nrf2, in neoplasia there is evidence for increased basal activation of Nrf2. Indeed, somatic mutations that disrupt the Nrf2-Keap1 interaction to stabilize Nrf2 and increase the constitutive transcription of Nrf2 target genes were recently identified, indicating that enhanced ROS detoxification and additional Nrf2 functions may …

Identification Of Factors Associated With Good Response To Growth Hormone Therapy In Children With Short Stature: Results From The Answer Program®., Peter A Lee, John Germak, Robert Gut, Naum Khutoryansky, Judith Ross

Department of Pediatrics Faculty Papers

UNLABELLED: ABSTRACT:

OBJECTIVE: To identify factors associated with growth in children on growth hormone (GH) therapy using data from the American Norditropin Studies: Web-enabled Research (ANSWER) Program® registry.

METHODS: GH-naïve children with GH deficiency, multiple pituitary hormone deficiency, idiopathic short stature, Turner syndrome, or a history of small for gestational age were eligible (N = 1,002). Using a longitudinal statistical approach, predictive factors were identified in patients with GHD for change from baseline in height standard deviation score (ΔHSDS) following 2 years of treatment.

RESULTS: Gradual increases in ΔHSDS over time were observed for all diagnostic categories. Significant predictive factors …

Download Entire Pdf: The Medicine Forum, Vol 9, 2007

The Medicine Forum

Download entire PDF: The Medicine Forum, Vol 9, 2007

What's Undocumented, Tamara Solitro, Md

The Medicine Forum

There’s a calm stillness

To the sick at night—

The sound of quiet healing, I hope,

But inevitably, a few cannot be healed.

Man With Malaria In Delaware, Benjamin Ngo, Md

The Medicine Forum

Case Presentation

A 37-year-old African American male presented to the hospital complaining of high fevers over the past two weeks associated with severe posterior headache. He described having had a very poor appetite recently, but denied any cough, abdominal pain, diarrhea, or urinary symptoms. He did not recall sustaining any head trauma. He did relate, however, that he had recently returned from a three-month trip to Kenya ~1 month prior to this presentation. He had no past medical history and was not on any medications. He did not use IV drugs. Physical exam confirmed a fever of 102.1o F though …

Spiderbite, Ayana Cannon, Md

The Medicine Forum

Introduction

In North America alone, there are more than 3,000 species of spiders. While most are harmless, several species including the Latrodectus (black widow), Atrax (funnel-web), and the Loxosceles (brown recluse) have been known to inflict varying degrees of injury to humans. While an overwhelming majority of spider bites may go unnoticed, others result in local skin reactions, necrotic cutaneous lesions, or a severe syndrome associated with hemolysis and death.

While proper identification of spider bites is paramount to the prevention of rare, life-threatening systemic reactions, their misdiagnosis can be equally hazardous. According to the literature, Loxosceles reclusa bites are …

A Man With Abdominal Pain And Acute Renal Failure, Faisal Shaikh Md, Marina Serper, Md

The Medicine Forum

Case Presentation

A 33 year-old African American male with a past medical history significant for HIV on HAART therapy presented to the emergency department (ED) with acute onset of right upper quadrant abdominal pain and mild shortness of breath. The abdominal pain was not associated with any fevers, chills, nausea, vomiting or diarrhea. The patient denied any chest pain, palpitations, lightheadedness or syncopal episodes. He did report some dysphagia with solids more than liquids over the last 2 months as well as decreased oral intake. His review of systems was otherwise significant for weight loss which he was unable to …

Infliximab-Induced Interstitial Lung Disease In A Patient With Psoriatic Arthritis, Lan Quang, Md, Anthony Scarpaci, Md

The Medicine Forum

Introduction

Infliximab (Remicade, Centocor, Inc., Malvern, PA), a chimeric monoclonal antibody derived from both murine and human antibody sequences and directed against TNF-α, is one of the disease modifying anti-rheumatic drugs (DMARDs) used in the treatment of psoriatic arthritis and other autoimmune inflammatory conditions such as rheumatoid arthritis, ankylosing spondylitis, and Crohn’s disease. It is commonly used in combination with methotrexate for increased efficacy and reduction of the development of anti-infliximab antibodies. A concerning feature of infliximab therapy is its association with an increased risk of infection or reactivation of diseases that can cause pulmonary complications, most notably tuberculosis and …

Immunocomprised Heart Transplant Patient With Cryptosporidial Diarrhea, Michael Dominic Lee, Msiii, Rajesh Kabadi, Md, Siva K. Kumar, Md

The Medicine Forum

Case Presentation

A 22 year-old female with a past medical history of postpartum cardiomyopathy status post orthotopic heart transplant (OHT) was admitted for diarrhea of 12 days’ duration. The diarrhea was watery, non-bloody, and occurring at a rate of 10 episodes per day. She denied nausea, vomiting, fever, or chills, but reported abdominal cramps. On physical exam, she was afebrile, and vital signs were stable. The patient had a regular heart rate and rhythm. Lung sounds were clear to auscultation bilaterally. Her abdomen was soft, non-tender, without rigidity, guarding, or distention. There was no edema in the extremities.

Vocal Cord Dysfunction In Asthmatics, Yvonne L. Mccarey, Md

The Medicine Forum

Case Presentation

A 44 year old female with a past medical history of type 2 diabetes, hypertension, congestive heart failure, coronary artery disease, 2 strokes, 2 myocardial infarctions, questionable history of pulmonary embolus twice, bipolar disorder, schizophrenia, and multiple asthma exacerbations presented to the Emergency Department (ED) with SOB and wheezing. Her symptoms began at home earlier that day and were not improved by bronchodilators. On arrival to the ED, she was lethargic in severe respiratory distress with laboring accessory muscle use. She had only an allergy to latex. Outpatient medications included albuterol inhaler, fluticasone/salmeterol inhaler, inhaled budesonide, furosemide, and …

Acuphagia, Saurabh Bansal, Md

The Medicine Forum

A 29 year old male with a history of swallowing objects and recent abdominal surgery presented to the emergency department (ED) after “accidentally” swallowing a pen. A chest radiograph was performed that verified the presence of the pen. The gastroenterology service performed an emergent EGD to remove the pen. Six hours after the procedure the patient signed out against medical advice. The patient returned to the ED 10 days later with complaints of hematemesis that was unwitnessed by any medical staff. On laboratory evaluation his hemoglobin was the same as the previous admission. Psychiatry subsequently interviewed the patient and found …

Foreign Body In The Small Intestine, Benjamin Creelan, Md

The Medicine Forum

Case Presentation

This adult was working on a ladder during a home restoration project. She placed the bit in her mouth while changing the screwdriver bit, then fell from the ladder and inadvertently swallowed the bit. In the emergency room, her review of systems and laboratories were unremarkable. Imaging revealed the bit to be within the duodenal lumen and after four days of serial xrays, the bit was retrieved by snare colonoscopy at the ileocecal junction. The patient remained asymptomatic and had no complications.

Chest Pain As A Presenting Symptom For Gastric Phytobezoar, Ankitkumar K. Patel, Md, Mph, Sandarsh Kancherla, Md, Darren Seril, Md

The Medicine Forum

Introduction

Chest pain is a common chief complaint of patient presentation to the emergency room. It also presents itself as one of the most challenging symptoms for clinicians to manage. The differential diagnosis for chest pain involves a multitude of organ systems. Failure to recognize potentially serious life-threatening causes such as acute ischemic heart disease, aortic dissection, tension pneumothorax, or pulmonary embolism can lead to serious morbidity and mortality. At the same time, overly conservative management of low-risk patients leads to unnecessary hospital admissions, studies and procedures.1 The following case illustrates the need to broaden the differential diagnosis for chest …

Trust Your Gut, Roger Coron, Md, Jennifer Hurd, Md, Steven Ludwin, Md, Patricia Kozuch, Md

The Medicine Forum

Case Presentation

MG is a 56-year-old female with no significant past medical history who presented to TJUH in October 2007 with a two year history of abdominal pain and weight loss. At presentation, she described her pain as non-radiating, 7 out of 10, gnawing, burning and located in the epigastrum and left upper quadrant. The pain initially occurred approximately 15 minutes postprandially and lasted 30 minutes. Over the two year period, the pain progressed to lasting for hours following meals. Dietary modifications and food consistency did not help the pain. The patient began avoiding oral intake, and her weight declined …

A 70-Year-Old Male With Abdonimal Pain, William H. Chong, Md

The Medicine Forum

Introduction

Acute pancreatitis is an acute inflammatory process of the pancreas. It is usually associated with severe acute upper abdominal pain and elevated blood levels of pancreatic enzymes. Serum amylase and lipase are common tests obtained as biochemical markers for acute pancreatitis. Pancreatitis, however, is not the sole cause of elevated pancreatic enzymes. Non-pancreatic causes of hyperamylasemia include inflammation or trauma to the salivary glands, bowel perforation or infarction, renal failure, abdominal trauma, and macroamylasemia.2 An unusual cause of elevated pancreatic enzymes is reported in this case report.

Hemochromatosis, Benjamin Creelan, Md

The Medicine Forum

Case Presentation

This 50 year-old adult male suffered from iron overload due to repetitive blood transfusions for HbSS sickle cell anemia. Computed tomography (CT) scan of the abdomen revealed high attenuation and massive enlargement of the liver consistent with hemochromatosis. A normal liver and spleen is included for comparison (inset). Splenic calcification is also noted, a rare finding in sickle cell anemia.

A 22-Year-Old Woman With Systemic Lupus Erythematosus Develops Cardiac Tamponade, Brooks Kuhn, Ms-Iii, Arthi Reddy, Md, Sorin Lazar, Md

The Medicine Forum

Introduction

Systemic lupus erythematosus (SLE) is a common cause of pericardial effusion and acute pericarditis, but very rarely it can cause cardiac tamponade.1 We describe the case of a young female with SLE who developed cardiac tamponade after finishing treatment for acute pericarditis with a small pericardial effusion.

Man With Flu-Like Symptoms, Sandarsh Kancherla, Md, Ankitkumar Patel, Md, Mph

The Medicine Forum

Case Presentation

A 69 year-old male presents to the Emergency Department with complaints of malaise, myalgias, rhinorrhea, increased congestion, and occasional fevers for one week. The symptoms have gradually worsened over the past week, and Tylenol has minimally alleviated his symptoms. He denies exacerbating factors. He denies any trauma, shortness of breath, chest pain, or recent weight change. He has no sick contacts or recent travel history.

A Case Report Of Idiopathic Giant Cell Myocarditis, Bao Bui, Md, Sumeet Chhabra, Md, Siva K. Kumar, Md

The Medicine Forum

Case Report

A 32 year old African American male was admitted to an outside hospital in July 2007 with symptoms of severe heart failure that required implantation of a short-term left ventricular assist device (LVAD). He was subsequently transferred to our facility due to worsening left ventricular heart failure, episodes of Torsades de Pointes, and monomorphic ventricular tachycardia. His device was replaced with a longer-term LVAD and he was discharged home in October. Fortunately, he underwent successful orthotopic heart transplant in November 2007.

A 41-Year-Old Woman With Rheumatic Mitral Stenosis, Atrial Fibrillation, And Right-Sided Heart Failure, Stephen Koczirka, Ms-Iii

The Medicine Forum

Case Presentation

A 41 year old Southeast Asian woman presented to the Emergency Department (ED) complaining of acute onset of nausea and abdominal pain as well as a two weeks of palpitations and two months of cough productive of white sputum. The patient also complained of fever, shortness of breath and dyspnea on exertion over the previous week. Patient history revealed a past medical history of asthma. The patient had no prior surgical or psychiatric history, had no known drug allergies, and consumed no chronic medications. The patient reported that she had immigrated to the United States from Laos in …

Left Atrial Myxoma, Siva K. Kumar, Md, Rajesh M. Kabadi, Md, Paul J. Mather, Md

The Medicine Forum

Case Presentation

A 65 year-old female with a past medical history of hypertension and diabetes presented to her cardiologist’s office with symptoms consistent with progressive heart failure over an eight month period. A transthoracic echocardiogram done in the office demonstrated a normal-appearing mitral valve and normal left ventricular systolic function. Additionaly, it also revealed a large left atrial myxoma (pictured above). The mass obstructed flow through the mitral valve, resulting in a mean valvular gradient of 18 mm Hg, consistent with mitral stenosis-like physiology. As a result of these findings, the patient was admitted to our institution for further evaluation. …