Medicine and Health Sciences Commons^™

Holding The Potential Cure In My Hand, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.

Patient Discomfort Associated With The Use Of Intra-Arterial Iodinated Contrast Media: A Meta-Analysis Of Comparative Randomized Controlled Trials, Peter A. Mccullough, Patrizio Capasso

Radiology Faculty Publications

BACKGROUND: Discomfort characterized by pain and warmth are common adverse effects associated with the use of intra-arterial iodinated contrast media (CM). The objective of this review was to pool patient-reported outcomes available from head-to-head randomized controlled trials (RCTs) and to compare the discomfort rates associated with iso-osmolar contrast media (IOCM; i.e., iodixanol) to those reported with various low-osmolar contrast media (LOCM).

METHODS: A review of the literature published between 1990 and 2009 available through Medline, Medline Preprints, Embase, Biological Abstracts, BioBase, Cab Abstracts, International Pharmaceutical Abstracts, Life Sciences Collection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed …

Factors Related To Knowledge And Perception Of Women About Smoking: A Cross Sectional Study From A Developing Country., Seema Bhanji, Marie Andrades, Fawad Taj, Ali K Khuwaja

Department of Family Medicine

Background: Smoking rates among women are currently low, but they are the fastest growing segment of cigarette smoking population in developing countries. We aimed to assess the knowledge and perceptions towards smoking and to identify the factors related with level of knowledge and perceptions among adult women in urban slums. Methods: This was a cross sectional study conducted on 250 adult (≥18 years of age) women attending primary care clinics in three slums of Karachi, Pakistan. A pre-tested and structured, interviewer administered questionnaire was used for data collection. Factors associated with level of understanding about smoking were analyzed with chi-square …

Ngos And Government Partnership For Health Systems Strengthening: A Qualitative Study Presenting Viewpoints Of Government, Ngos And Donors In Pakistan, Iram Ejaz, Babar T. Shaikh, Narjis Rizvi

Community Health Sciences

Background: Health systems are expected to serve the population needs in an effective, efficient and equitable manner. Therefore, the importance of strengthening of public, private and community health systems has been emphasized time and again. In most of the developing countries, certain weaknesses and gaps in the government health systems have been hampering the achievement of improved health outcomes. Public sector in Pakistan has been deficient in the capacity to deliver equitable and quality health services and thus has been grossly underutilized.Methods: A qualitative study comprising in-depth interviews was conducted capturing the perceptions of the government functionaries, NGO representatives …

Oral Ingestion Of Hexavalent Chromium Through Drinking Water And Cancer Mortality In An Industrial Area Of Greece - An Ecological Study, Athena Linos, Athanassios Petralias, Costas A. Christophi, Eleni Christoforidou, Paraskevi Kouroutou, Melina Stoltidis, Afroditi Veloudaki, Evangelia Tzala, Konstantinos C. Makris, Margaret R. Karagas

Dartmouth Scholarship

Background: Hexavalent chromium is a known carcinogen when inhaled, but its carcinogenic potential when orally ingested remains controversial. Water contaminated with hexavalent chromium is a worldwide problem, making this a question of significant public health importance.

Methods: We conducted an ecological mortality study within the Oinofita region of Greece, where water has been contaminated with hexavalent chromium. We calculated gender, age, and period standardized mortality ratios (SMRs) for all deaths, cancer deaths, and specific cancer types of Oinofita residents over an 11-year period (1999 - 2009), using the greater prefecture of Voiotia as the standard population.

Results: A total of …

Mitochondrial Oxidative Stress Drives Tumor Progression And Metastasis: Should We Use Antioxidants As A Key Component Of Cancer Treatment And Prevention?, Federica Sotgia, Ubaldo E Martinez-Outschoorn, Michael P Lisanti

Department of Stem Cell Biology and Regenerative Medicine Faculty Papers & Presentations

The functional role of oxidative stress in cancer pathogenesis has long been a hotly debated topic. A study published this month in BMC Cancer by Goh et al., directly addresses this issue by using a molecular genetic approach, via an established mouse animal model of human breast cancer. More specifically, alleviation of mitochondrial oxidative stress, via transgenic over-expression of catalase (an anti-oxidant enzyme) targeted to mitochondria, was sufficient to lower tumor grade (from high-to-low) and to dramatically reduce metastatic tumor burden by >12-fold. Here, we discuss these new findings and place them in the context of several other recent studies …

Underestimation Of Weight And Its Associated Factors Among Overweight And Obese Adults In Pakistan: A Cross Sectional Study, Seema Bhanji, Ali Khan Khuwaja, Fawad Siddiqui, Iqbal Azam Syed, K. Kazmi

Department of Family Medicine

Background: Weight loss is known to decrease the health risks associated with being overweight and obese. Awareness of overweight status is an important determinant of weight loss attempts and may have more of an impact on one's decision to lose weight than objective weight status. We therefore investigated the perception of weight among adults attending primary care clinics in Karachi, Pakistan, and compared it to their weight categories based on BMI (Body Mass Index), focusing on the underestimation of weight in overweight and obese individuals. We also explored the factors associated with underestimation of weight in these individuals.
Methods: This …

Academic Detailing To Increase Colorectal Cancer Screening By Primary Care Practices In Appalachian Pennsylvania, William J. Curry, Eugene J. Lengerich, Brenda C. Kluhsman, Marie A. Graybill, Jason Z. Liao, Eric W. Schaefer, Angela M. Spleen, Mark B. Dignan

Internal Medicine Faculty Publications

BACKGROUND: In the United States, colorectal cancer (CRC) is the third most frequently diagnosed cancer and second leading cause of cancer death. Screening is a primary method to prevent CRC, yet screening remains low in the U.S. and particularly in Appalachian Pennsylvania, a largely rural area with high rates of poverty, limited health care access, and increased CRC incidence and mortality rates. Receiving a physician recommendation for CRC screening is a primary predictor for patient adherence with screening guidelines. One strategy to disseminate practice-oriented interventions is academic detailing (AD), a method that transfers knowledge or methods to physicians, nurses or …

Medical School Watercooler Newsletter - May 22, 2011, Lindsey Lyle

Watercooler Newsletter

This is the May 22, 2011 edition of the Frederick P. Whiddon College of Medicine's newsletter - watercooler

Contents Include

• June Med School Café - "The Gift of Life: Reasons to Give If You Are Asked"

• Dr. Ballard Continues Cystic Fibrosis Research

• Blood Drive To Be Held in Honor of USA Medical Student

• USA Pain Clinic Opens in Newly Renovated Mastin Professional Building

• Dr. Thomas Lincoln Featured in Press-Register

• A Look Back on the Career of Retired Radiology Professor

Cardiovascular Disease And Post Traumatic Stress Disorder In Adults Exposed To The Terrorist Attacks On The World Trade Center, Katie C. Imhof

Master of Public Health Program Student Publications

Following events of terrorism communities and individuals are subject to the cumbersome responsibilities associated with rescue and recovery efforts. In addition to the loss of life and direct injuries sustained during the incident, long term health outcomes among the exposed population are often seen. Both physical and mental health can be affected as a result of the exposure, and some outcomes do not immediately present themselves. The population exposed to the September 11, 2001 terrorist attacks on the World Trade Center in New York City is no different, and the World Trade Center Health Registries database has been established by …

Controlling The Activity Of A Phosphatase And Tensin Homolog (Pten) By Membrane Potential, Jérôme J. Lacroix, Christian R. Halaszovich, Daniela N. Schreiber, Michael G. Leitner, Francisco Bezanilla, Dominik Oliver, Carlos A. Villalba-Galea

School of Pharmacy Faculty Articles

The recently discovered voltage-sensitive phosphatases (VSPs) hydrolyze phosphoinositides upon depolarization of the membrane potential, thus representing a novel principle for the transduction of electrical activity into biochemical signals. Here, we demonstrate the possibility to confer voltage sensitivity to cytosolic enzymes. By fusing the tumor suppressor PTEN to the voltage sensor of the prototypic VSP from Ciona intestinalis, Ci-VSP, we generated chimeric proteins that are voltage-sensitive and display PTEN-like enzymatic activity in a strictly depolarization-dependent manner in vivo. Functional coupling of the exogenous enzymatic activity to the voltage sensor is mediated by a phospholipid-binding motif at the interface between voltage sensor …

Download Entire Pdf: The Medicine Forum, Vol 5, Winter 2003

The Medicine Forum

Download entire PDF: The Medine Forum, (The Journal of Thomas Jefferson University Hospital, Department of Internal Medicine), Vol 5, Winter 2003.

Clinical Quiz

The Medicine Forum

5 question clinical quiz. Answers after case presentation: A Man with Dyspnea and Diffuse Abdominal Pain by Dominick Galluzzo MD.

Effect Of Intravenous Pulse Cyclophosphamtoe (Cyc) Therapy On Systemic Sclerosis (Ssc) Inflammatory Lung Disease, Nicole Weinberg, Md, Nora Sandorfi, Md, Sergio A. Jimenez, Md

The Medicine Forum

Deterioration of lung function is the most frequent cause
of death in SSc. Alveolitis is considered the initiating
event of SSc lung fibrosis. Effective therapy of SSc
alveolitis is, therefore, of paramount importance. Here
we assessed the use of intravenous CYC on pulmonary
function testing(PFT) and high resolution computerized
tomography (HRCT) abnormalities in 15 patients with
SSc and alveolitis.

Effects Of Walnut Consumption As Part Of Heart Healthy Diet On Atherogenic Lipoprotein Subclasses, Kimberly L. Dulaney, Md, John M. Morgan, Md, David M. Capuzzi, Md

The Medicine Forum

Nutritional therapy is fundamental in the treatment of
cardiovascular disease. Studies that utilized a low-fat diet
supplemented with 64 grams/day of walnuts have shown
a significant reduction in serum levels of total and LDL
cholesterol, and triglycerides. This study was designed to
see if lipoprotein subclasses varied in patients eating a
low-fat walnut supplemented diet.

A Man With Shortness Of Breath And An Abnormal Ecg: A Short Case, David Defeo, Md

The Medicine Forum

An 80 year-old Chinese male with a history of tobacco
use and asthma presented to the ER complaining of
shortness of breath that was unresponsive to
bronchodilator use. The patient’s ECG on admission was
sinus rhythm at 95 beats per minute with minimal ST
elevations in V2-V4. Laboratory results were significant
for a troponin of 7.7. The patient was started on anticoagulation
with heparin. A transthoracic echocardiogram
revealed an ejection fraction of 25%. The patient
underwent coronary catheterization, which revealed
luminal irregularities of his coronary arteries. Figures 1
and 2 show the end diastolic and end systolic left
ventriculograms from …

An Unresponsive Woman Found Down, Murliya Gowda, Md

The Medicine Forum

A middle-aged unidentified female presented by fire
rescue to the emergency department after being found
unconscious in the snow. Her identity, familiar contacts,
and medical history were not known, but the patient was
presumed to be homeless.

A Woman With Headache And Chest Pain, Theresa Pondok, Md

The Medicine Forum

A 34 y/o woman, with a past medical history significant
for asthma, newly diagnosed hypertension, and migraines,
presented to the emergency department with complaints
of sudden onset chest pain. She was an active young
woman, who up until the day of admission, had been able
to run several miles without chest pain or shortness of
breath. Symptoms began the morning of admission, when
the patient reported that she developed a migraine
heachache, with typical right-sided temporal pain. After
administering an injection of Sumatriptan, her headache
resolved. Soon thereafter, she noted 5/10 substernal chest
pressure occurring suddenly at rest, without radiation …

A Man With Shortness Of Breath And Bloating, Matthew E. Levy,Md

The Medicine Forum

The patient is a 61-year-old male with a past medical
history of hypertension and insulin-dependent diabetes
mellitus presented to the ED with new onset shortness
of breath. He reported a three week progression of
dyspnea after one flight of stairs, from a normal baseline.
The patient also noticed 2 pillow orthopnea and
increased urinary frequency and urgency. He denied
fevers, chills, chest pain, palpitations or productive
cough. Symptoms began when he ran out of his oral
medications three weeks prior to admission (furosemide,
enalapril, digoxin, metoprolol, spironolactone, aspirin).
Family history was positive for alcoholic cirrhosis. Social
history was positive for …

Training Residents In Acls/Code Response Using A Computerized Medical Simulator: Improving Resident Comfort And Preparedness, Elisabeth Dial, Md, Henry Schairer, Md, Steven Silver, Md, Jennifer Claves, Md, David Gardiner, Md, John Caruso Md, Salvatore Mangione, Md, Gregory C. Kane, Md

The Medicine Forum

Internal Medicine residents are responsible for leading the
code response team at most teaching hospitals, yet many
graduating interns (PGY1s) may feel unprepared to run
codes. Currently, the only formal training for house staff
is the two-day American Heart Association’s Advanced
Cardiac Life Support (ACLS) course, generally required at
the beginning of internship, with recertification necessary
every two years. This course does not address leadership
skills or a resident’s self-reported sense of comfort with
leading a code team within a teaching hospital. Prior
investigations have highlighted the deterioration in
knowledge of important ACLS protocols, with knowledge
levels at or near …

A Woman With Extreme Fatigue, Christopher Dimaio Md, Chief Medical Resident

The Medicine Forum

A 23 year old female presented to her primary care
provider’s office complaining of extreme fatigue over the
past few weeks.

Color Photos

The Medicine Forum

10 color photographs.

Isolated Abducens Nerve Palsy Secondary To Varicella Zoster In A Patient With Hiv, Ellen B. Lunenfeld, Md, John A. Walker, Md

The Medicine Forum

17
Varicella Zoster, the recrudescence of the dormant
varicella virus, occurs more often in older patients and
in those who are immunocompromised. Herpes Zoster
ophthalmicus (HZO) is the second most common
manifestation of the disease, second only to thoracic and
lumbar zoster.1 HZO is estimated to account for 10% to
25% of cases.2,3 HZO can lead to a number of ocular
complications, including proptosis, disciform keratitis,
internal ophthalmoplegia, bilateral retinal detachments,
Argyll-Robertson pupil, and progressive outer retinal
neuropathy (PORN).

A Man With Fevers And Chest Pain, Jigar Patel, Md

The Medicine Forum

A 42 y/o Hispanic man without significant medical
history presented to the ED with the complaint of
increasing left-sided chest pain. The patient reported that
symptoms began 4 days prior, when he developed a
severe headache. That night, he noted increasing chills
and sweats, with a fever measured at 103 degrees F. The
following morning, he developed left-sided chest pain
that he described as a pressure exacerbated by movement
and breathing. For the next several days, he reported
feeling worse with continuous chills and fever spikes up
to 105 degrees F, along with increased severity and
duration of his chest …

A Male With Chills And Arthralgias, Lo-Ku Chiang, Md, Ambrish Ojha, Md

The Medicine Forum

A 53-year old man presented to the ED with complaints
of fevers and chills for 5 days. Two days prior, he started
having generalized arthralgias and a painfully numb left
index finger. Similar symptoms had also begun on his
left great toe (See Figures D and E, Color Plates page
19). The patient denied recent trauma, although he was
unsure if he had sustained an insect bite on the dorsal
aspect of his left hand 8 hours prior to the onset of
symptoms. Three sets of blood cultures obtained prior
to admission were positive for methacillin-sensitive
Staphylococcus aureus. The patient …

A Man With Dyspnea And Diffuse Abdominal Pain, Dominick Galluzzo Md

The Medicine Forum

A 50 y/o male with a PMH significant for HIV/HCV
co-infection, and chronic renal insufficiency, presented
to the ED with a one week history of progressive dyspnea
and diffuse abdominal discomfort. He reported resting
shortness of breath without orthopnea, PND, or chest
pain. His abdominal pain was diffuse, and he denied
nausea, vomiting, increased abdominal girth or lower
extremity edema.

Prevention Of Central Venous Catheter-Related Infections, Raghuram Mallya, Md

The Medicine Forum

The central venous catheter is a valuable tool in inpatient
medicine. However, with its use comes the risk of local
and systemic infections. Kluger et al estimated that
250,000 cases of central line-associated blood stream
infections occur annually. Mortality rates range from 12-
25% per infection.1 Therefore, it is essential that health
care providers take all necessary precautionary measures
to avoid infection. Guidelines have been published by the
Centers for Disease Control and Prevention to provide
an evidence-based medicine (EBM) approach for
avoiding central venous catheter-related infections.
Recommendations include proper skin cleansing, the use
of maximal sterile barriers, selection of …

A Man With Diarrhea And Achalasia, Dan Valancius Md

The Medicine Forum

A 78 y/o male with an extensive history of CAD s/p
multiple MIs and CABG surgery, presents with two and
one half weeks of diarrhea. About 9 weeks prior, he had
been diagnosed with achalasia, and was treated with a
botulinum toxin injection, with resolution of his
symptoms of dysphagia. He was also hospitalized a month
ago after experiencing chest pain, and subsequently ruled
in for a small non-ST elevation MI. He underwent
coronary catheterization at that time, and was found to
have severe multivessel disease unamenable to PTCA or
bypass surgery. Now, he presents with progressively
frequent “brown watery” …

A Man With An Elevated Hemoglobin, Paula Sorokanich Md

The Medicine Forum

A 50-year-old male with history of severe gout and
degenerative joint disease presented to his PCP for a
physical. On routine blood work he was found to have
an elevated hemoglobin/hematocrit. This was confirmed
on repeat analysis and work-up was pursued.

A Man With A Soft Tissue Lesion Of The Hand, Susan Masonis Md

The Medicine Forum

A fifty year old male presents with a lesion on his right
hand. Approximately 2 months prior to presentation, the
patient, who is a dentist and avid boater, first noted the
lesion after hitting his hand when working in his boat’s
engine room. Initially he had a 1 cm erythematous
macular lesion on the dorsum of his right hand at the
5th metacarpal. He believed the lesion was present prior
to the time he struck his hand, and the injury brought it
to his attention.