Medicine and Health Sciences Commons^™

Imp2 Expression In The Mouse Nervous System, Sarah E. Chmielewski, Paige E. Black, Tiffany M. Holmes, Kelly S. Lau, Gary J. Bassell

Research Day

Background: Insulin-like growth factor-II (IGF-II) mRNA-binding protein-2 (IMP2) is one of the three homologs (IMP1-3) that play important roles in the posttranscriptional regulation of gene expression in several tissues. IMP1/ZBP1 (zipcode binding protein) has been shown to play important roles in axon guidance and regeneration by regulating the localization and translation of specific mRNAs. However, the function of IMP2 is least understood, largely because an isoform-specific antibody is not available, which makes the conventional techniques to locate protein expression not feasible.

Predicting Acute Urinary Retention In Patients With Elevated Post Void Residuals, David B. Cahn Mbs, Curtis P. Ross Do, Michelle L. Persun Md, Philip C. Ginsberg Jd, Do

Research Day

Objectives: To perform a retrospective analysis in order to evaluate factors that may help predict which men with elevated PVRs that were at increased risk to develop AUR.

Effects Of Non-Aerobic Maximal Effort Exercise On Fatigue In Deconditioned Men And Women With Multiple Sclerosis, Jessica U. Korsh, Michael L. Kuchera, R T. Dombroski, T Vardy, F Thomas, S O’Brien, P Yagnik, K Wenzel, S Stoll, Bruce C. Stouch, M T. Wallin, Jeffrey A. Nelson

Research Day

Multiple Sclerosis (MS) is a neurodegenerative disease of unknown etiology affecting women more frequently than men. Mental and physical fatigue complaints are often the most disabling symptoms for an MS patient. Both are multifactorial, potentially exacerbated by aerobic exercise, may prevent sustained physical functioning, and significantly interfere with activities of daily living1. A multi-center study was designed to investigate the effects of non-aerobic maximal effort exercise (MEE) for deconditioned persons with MS, with the expectation of minimizing fatigue. The IsoPUMP (Neuromuscular Engineering; Nashville, TN), is a specialized exercise and strength-sensing machine, designed to allow individuals to safely perform and record …

Documenting Pressures Used For Manual Diagnosis And Treatment Of Cervical Spine Somatic Dysfunction, Joseph Yoha, Michael L. Kuchera, Precious Barnes, Frank Casella, Jeffrey A. Nelson

Research Day

Background: Palpatory assessment of free or restricted motion patterns is part of the diagnosis of spinal somatic dysfunction (SD). Diagnostically, local soft tissues are compressed (pre-loaded) over the structure of interest followed by one or more test impulses to assess the quality of the “end-feel” motion in several planes. These barrier sensations are often described qualitatively but have not been objectively quantified. Noninvasive, tactile pressure sensors built into a digital palpation monitoring system (IsoTOUCH®; Neuromuscular Engineering; Nashville TN, USA) were used to document loading and impulse pressures for palpatory segmental diagnosis and to first engage and then quickly move …

An Analysis Of Functional Status In Multiple Sclerosis Patients After Progressive Non-Aerobic High-Intensity Maximal Effort Exercise (Mee), Hilda Lai, Michael L. Kuchera, R T. Dombroski, T Vardy, F Thomas, S O’Brien, P Yagnik, K Wenzel, S Stoll, Bruce C. Stouch, M. T. Wallin, I. Vargas,, Olufolake Odutola

Research Day

Background: Multiple Sclerosis (MS) is a disease with a wide-ranging impact on functional status. MS patient function has been assessed using Multiple Sclerosis Functional Composite Score (MSFCS). The MSFCS includes the standardized scores (Z-score) of three functional tests: the Paced Auditory Serial Addition Test (PASAT-3”) for cognitive function, 9-Hole Peg Test (9-HPT) for upper extremity function, and timed 25-foot walk (25-TW) for lower extremity function. One of the most common symptoms experienced by MS patients is severe fatigue, often brought on suddenly by aerobic exercise. Non-aerobic maximal effort exercise (MEE) is thought to increase strength without increasing fatigue. The …

Mechanisms Of Mouse Hepatitis Virus Entry Into Cells, Philip J. Koehler, Kristina Cade, Fiora D. Zoga, Susan T. Hingley

Research Day

Background: Viruses can enter cells through several mechanisms, two common ones being clathrin-mediated and caveolin-mediated endocytosis. The clathrin pathway delivers viral particles to endosomes, with subsequent acidification of the endosome and endosome/lysosome fusion often a prerequisite for release of the viral genome into the cytoplasm. The caveolin-mediated pathway delivers virus initially into vesicles called caveosomes, which have a neutral pH, before viral uncoating occurs. Viral entry pathways can be examined by using various drugs to inhibit the different endocytosis pathways, as well as by siRNA technology to down-regulate expression of clathrin or caveolin proteins on the surface of host …

Characterization Of A Small Iron Protein, Pyrococcus Furiosus Rubredoxin, As A Potential Cancer Drug Delivery System, Siri L. Chirumamilla, David L. Blum, Ray L. Mernaugh, Francis E. Jenney

Research Day

Background: Cancer is an elusive neoplastic disease that claims the lives of many people around the world every year. Though treatments have become more specific to the different types of cancer, the need for antineoplastic drugs that target cancer cells and leave normal cells unharmed, with little to no systemic toxicity remains, and rubredoxin might be such a tool. Rubredoxin is a small (53 amino acids), water soluble, non-heme iron electron transfer protein that contains an iron atom cofactor, which can be substituted with various cytotoxic transition metals such as nickel and cobalt with little or no effect on …

Changes In Expression Of Genes Associated With Autophagy And Apoptosis In Neuronal Cells Infected With Hsv-1may Suggest Infection-Induced Mechanisms Of Neurodegeneration, Alexis Mark, Fiora D. Zoga, Brian J. Balin Phd, Denah M. Appelt Phd, Susan T. Hingley

Research Day

Background:This study investigates the potential role of herpes simplex virus type 1 (HSV-1) in the pathogenesis of neurodegenerative disorders, such as Alzheimer’s disease (AD), by exploring changes in gene expression related to antiviral immunity and the autophagic pathway. Autophagy is a process that recycles organelles and proteins to create more energy for the cell. This pathway has been linked to neurodegeneration, as malfunctions in the completion of this process lead to a decline in overall cellular health and function. Interestingly, HSV-1 has been shown to block the completion of autophagy, which would potentially contribute to the cytopathic changes observed …

The Effects Of Dihydrobiopterin And Tetrahydrobiopterin On Hydrogen Peroxide And Nitric Oxide Release During Extracorporeal Shockwave Lithotripsy, Brittany L. Deiling, Edward S. Iames, Kerry-Anne Perkins, Qian Chen Phd, Lindon H. Young Phd

Research Day

Extracorporeal shockwave lithrotripsy (ESWL) is an effective, non-invasive clinical therapy utilized to break up stones in the kidney and urinary tract. A lithotripter generates high-energy acoustic pulses and propagates those shock waves through a lens on a region that focuses on the location of the stone, in turn breaking up the stone. The successive pulses generate shearing forces and cavitation bubbles. Cavitation bubbles are the formation and implosion of liquid free zones. The cavitation bubbles implode rapidly to create their own shockwaves that also put pressure on the stone. After treatment, fragmentation of the stone allows the debris to be …

The Human Pathogen Clostridium Dificle: A Look At A Putative Involved In Protection From Oxidative Stress, Tashinea Lee, Francis E. Jenney

Research Day

Background: Hospital acquired infections due to Clostridium difficile (C. diff) is associated with nosocomial diarrhea and pseudomembranous colitis. Using a published microarray analysis of C. diff strain 630, several open reading frames (ORFs) were noted for their upregulation under different environmental stresses. One of these genes (CD1134) is a putative glyoxalase I. The glyoxalase enzymes detoxify a side product of glycolysis, methylglyoxal, and use metals as a cofactor.

Case Report: Rapid Spontaneous Recovery From Severe Hypothyroidism In 2 Teenage Girls., Paul B. Kaplowitz

Pediatrics Faculty Publications

Background

While it is recognized that patients sometimes recover from autoimmune hypothyroidism, little is known about how rapidly this may occur.

Case reports

Two 13 year old girls had severe primary hypothyroidism (total T4 14.2 nmol/L with TSH 468 miU/L and total T4 7.7 nmol/L with TSH 183 miU/L) accompanied by goiter and positive thyroid peroxidase antibodies. There were delays in starting thyroid hormone replacement, and complete reversal of hypothyroidism was documented within 2 months in both cases. One of the girls had recurrence of severe hypothyroidism after being euthyroid for 18 months.

Review of literature

There are few published …

Eye Size At Birth In Prosimian Primates: Life History Correlates And Growth Patterns, Joshua R. Cummings, Magdalena N. Muchlinski, E. Christopher Kirk, Susan J. Rehorek, Valerie B. Deleon, Timothy D. Smith

Neuroscience Faculty Publications

BACKGROUND: Primates have large eyes relative to head size, which profoundly influence the ontogenetic emergence of facial form. However, growth of the primate eye is only understood in a narrow taxonomic perspective, with information biased toward anthropoids.

METHODOLOGY/PRINCIPAL FINDINGS: We measured eye and bony orbit size in perinatal prosimian primates (17 strepsirrhine taxa and Tarsius syrichta) to infer the extent of prenatal as compared to postnatal eye growth. In addition, multiple linear regression was used to detect relationships of relative eye and orbit diameter to life history variables. ANOVA was used to determine if eye size differed according to activity …

Pv1 Down-Regulation Via Shrna Inhibits The Growth Of Pancreatic Adenocarcinoma Xenografts, Sophie J. Deharvengt, Dan Tse, Olga Sideleva, Caitlin Mcgarry, Jason R. Gunn, Daniel S. Longnecker, Catherine Carriere, Radu V. Stan

Dartmouth Scholarship

PV1 is an endothelial-specific protein with structural roles in the formation of diaphragms in endothelial cells of normal vessels. PV1 is also highly expressed on endothelial cells of many solid tumours. On the basis of in vitro data, PV1 is thought to actively participate in angiogenesis. To test whether or not PV1 has a function in tumour angiogenesis and in tumour growth in vivo, we have treated pancreatic tumour-bearing mice by single-dose intratumoural delivery of lentiviruses encoding for two different shRNAs targeting murine PV1. We find that PV1 down-regulation by shRNAs inhibits the growth of established tumours derived from two …

Frequency And Associated Factors For Anxiety And Depression In Pregnant Women: A Hospital-Based Cross-Sectional Study., Niloufer Sultan Ali, Iqbal Azam Syed, Badar S. Ali, Ghurnata Tabbusum, Sana S. Moin

Department of Family Medicine

Antepartum anxiety and/or depression is a major public health problem globally. The aim of this study was to estimate the frequency of antepartum anxiety and/or depression among pregnant women. This was a cross-sectional study conducted in a tertiary care hospital among pregnant women. A total of 165 pregnant women were interviewed by a clinical psychologist using HADS for assessing anxiety and/or depression and also collected information regarding sociodemographic, obstetric, family relationships, and home environment. Out of the total of 165 pregnant women about 70 percent of them were either anxious and/or depressed. The increasing age of women (P-value = 0.073), …

Radiation Sensitization Of Breast Cancer Cells By Vitamin D Through The Promotion Of Autophagic Cell Death, Eden Wilson

Theses and Dissertations

Radiation therapy is a widely used tool in cancer therapy and is frequently offered as the first line of treatment for cancers of the breast. While radiotherapy is often initially effective in killing tumor cells or suppressing their growth, there are factors that confer tumor cell resistance to irradiation. Development of resistance may lead to disease recurrence despite the use of surgery, chemotherapy and radiation therapy. A primary goal of the studies in Dr. Gewirtz’s laboratory is to develop strategies to overcome resistance to radiation (and chemotherapy) in breast cancer, with the ultimate goal of preventing or attenuating disease recurrence. …

The Antecedents, Process, And Consequences Of Female Sterilization For Low-Income Women In Mumbai, Marie A. Brault

Master's Theses

Surgical sterilization is the primary method of family planning among low-income women in India; the result of limited knowledge and poor access to family planning alternatives. To understand the dynamics of sterilization, 37 in-depth interviews were conducted with sterilized women from the study community, as well as key informant interviews with community men, providers and government officials. The results indicate that sterilization decisions are made after exceeding ideal family size, that the procedures for sterilization frequently do not follow official protocol, but that for the most part women are highly positive about being free of the risk of unwanted conception.

Corneal Replication Is An Interferon Response-Independent Bottleneck For Virulence Of Herpes Simplex Virus 1 In The Absence Of Virion Host Shutoff, Tracy J. Pasieka, Vineet D. Menachery, Pamela C. Rosato, David A. Leib

Dartmouth Scholarship

Herpes simplex viruses lacking the virion host shutoff function (Δvhs) are avirulent and hypersensitive to type I and type II interferon (IFN). In this study, we demonstrate that even in the absence of IFN responses in AG129 (IFN-αβγR^−/−) mice, Δvhs remains highly attenuated via corneal infection but is fully virulent via intracranial infection. The data demonstrate that the interferon-independent inherent replication defect of Δvhs has a significant impact upon peripheral replication and neuroinvasion.

How Will Comparative Effectiveness Research Influence Clinical Decision Making?, Nicholas Zaorsky, Md, Timothy Showalter, Md

The Medicine Forum

Most health care recommendations in the United States have come from trials designed to measure efficacy of medical interventions, with randomized controlled trials considered the gold standard for evidence-based medicine. Comparative effectiveness research has become an essential component of research to help define the benefits, risks, and effectiveness of different interventions for a particular illness. Comparative effectiveness research is informally defined as an assessment of all available options for a specific medical condition, with intent to estimate effectiveness in specific subpopulations. In this article, we contrast efficacy-based healthcare research and recommendations in the United States, under the model of evidencebased …

An American On Rotation In Switzerland, Jennifer Alloo Hong, Md

The Medicine Forum

It wasn’t easy getting to Switzerland. My husband started work at CERN at the end of 2009 when I was a 3rd year medical student and I was there helping him find an apartment during my winter break. In the back of my mind, I wondered if I could do an away rotation at les Hopitaux Universitaires de Genève (HUG) the following year. So I walked into the front entrance of the medical school associated with HUG. Bonjour! Do you have a program for students like me? Is it allowed for foreigners? Would I have to take a test in …

Quality Improvement Of Diabetic Care At A Resident Clinic, Carmi Santos Punzalan, Md, Sarah Rutherford, Md, Andrew Lerner, Md, Tasha Kouvatsos, Md, Sneha Thakkar, Md, Melissa Klein, Md, David Manoff, Md, Cecilia Kelly, Md, Dina Halegoua, Md, Gregory Kane, Md

The Medicine Forum

Our objective was to develop a quality improvement project on diabetes mellitus at our internal medicine residency clinic. Residents developed projects aimed at improving an aspect of diabetic care. Continuity of care, achievement of clinical targets, no-show rates, patient knowledge of diabetes, and preventive care were evaluated. Our data was obtained with a questionnaire and a retrospective review of medical records. A different provider was scheduled about every 1.78 visit. The no-show rate was 25.4%. About half of patients identified goal hgbA1c and BPs, and 35% and 60% achieved their hgbA1c and SBP goals respectively. Nearly all of the charts …

Persistent Severe Hyperkalemia In A Patient With Normal Renal Function, Michael L. Tobin, Md

The Medicine Forum

Case Report

A 75-year-old female with a past medical history significant for hypertension, hyperlipidemia, and colon cancer, status post colectomy with ileostomy, presented to the Methodist Hospital emergency room with muscular low back pain, which began a few hours prior, after abruptly bending over. Upon arrival to the hospital, she had no other complaints and noted that the back pain was starting to resolve without intervention.

In triage, her heart rate was measured at 38 beats per minute (BPM) with her other vital signs within normal limits. Her electrocardiogram (EKG) was read as a junctional rhythm with a rate of …

Sarcomatoid Mesothelioma In A Patient With Asbestos Exposure, Abhik Roy, Md, Merritt Brown, Md

The Medicine Forum

Case

A 76-year-old man with no significant past medical history presented with a two month history of progressive shortness of breath, 25-pound weight loss, and sharp right-sided chest, abdomen, and pelvic pain without radiation. The patient noted his dyspnea became more pronounced in recent weeks, notably worse with climbing stairs or performing work around the house. He described the pain as having a positional component, and exacerbated with deep-inspiration. On further questioning, the patient reported a 50-pack-year history of smoking and past exposure to asbestos while working with heating insulation. Physical examination revealed an age-appropriate, but cachectic appearing male with …

A 45-Year-Old Male With Hiv, Kaposi’S Sarcoma, And Squamous Cell Carcinoma Of The Skin, Jascha Rubin, Md, Hasan Bayat, Md

The Medicine Forum

Case

A 45-year-old male with a history of human immunodeficiency virus, (HIV), on highly active antiretroviral therapy (HAART), Kaposi’s sarcoma, and squamous cell carcinoma (SCC) of the right lower extremity complicated by chronic wound formation presented with worsening right leg pain and increasing wound drainage.

The patient described the pain as excruciating, with 10/10 intensity and exacerbated by movement. His wounds began draining purulent material and blood about two weeks prior to presentation. He has had several similar, though milder episodes in the past requiring hospitalization. When the wounds began to have a foul odor, he presented to the hospital. …

Thrombotic Thrombocytopenic Purpura Revisited: Upshaw Schulman Syndrome In A 20-Year-Old Male, Judy Wang, Md, Niluk Peiris, Md

The Medicine Forum

Case Report

A 20-year-old male with no significant past medical history presented to an outside hospital with a two-week history of progressive fatigue, malaise and decreased appetite. Prior to these events, he had been in his usual state of health with normal exercise tolerance and energy level. Upon development of his symptoms, the patient felt as though he had developed an upper respiratory infection (URI). The URI symptoms eventually resolved; however complaints of fatigue and malaise still remained. He then developed progressive dyspnea on exertion and tea-colored urine. The patient reported a singular febrile episode to 38.9˚C associated with nonbilious …

A Case Of Pyoderma Gangrenosum, Christopher T. Miller, Md

The Medicine Forum

Case Report

A 60-year-old man with past medical history of hypertension, post-traumatic stress disorder, major depression, hepatic steatosis, chronic kidney disease, and untreated hepatitis C virus (genotype 1b) initially presented to the outpatient primary care clinic with a chief complaint of an extremely painful right lower extremity ulcer that had developed and grown progressively larger after mild trauma against a metal corner 4 months prior to the appointment. He admitted to picking at the granulation tissue that would develop over the ulcer. He was treating the ulcer with antibiotic ointment. On initial exam, the ulcer was about 2x2 cm, located …

Two Cases Of Co-Infection With Babesiosis And Lyme Disease, Anthony Decicco, Md, B. Niluk Peiris, Md, Cecilia Kelly, Md, Michael Latreille, Md, Donald Jungkind, Phd

The Medicine Forum

Case 1

The patient is a 71-year-old female with past medical history significant for hypothyroidism and hyperlipidemia who presented to Thomas Jefferson University Hospital (TJUH) with complaints of myalgias for 6 weeks duration. The patient stated that she had begun an exercise program to lose weight and had subsequently noticed body aches and increased fatigue. She had presented to an outside hospital with these complaints, was told that the etiology was musculoskeletal, and was prescribed naproxen for pain relief. The pain did improve slightly with the naproxen but she noticed a rash and hives after starting the medication and stopped …

A Case Of A 32-Year-Old Female With Right-Sided Facial Droop And Numbness, Jason Schoenfeld, Msiii, Efstathia Andrikopoulou, Md

The Medicine Forum

Case Presentation

A 32-year-old Hispanic female with a past medical history of asthma, depression and insomnia presented to the emergency room with complaints of right-sided facial droop associated with ipsilateral facial numbness and diminished taste for the past three days. In addition, she reported a moderate to severe pulsatile headache for the past day. This headache was initially right-sided and frontal, but then became right-sided and occipital in location. She had a history of a similar headache episode four years ago. Additionally, she noted moderately severe intermittent chest pain described as sharp then dull occurring over the past day. On …

Mycobacterium Fortuitum Device Infection With Subsequent Endocarditis, Paurush Shah, Md, Alec Vishnevsky, Md

The Medicine Forum

Case

A 78-year-old female with a past medical history of mild dementia, hypertension, diabetes, coronary artery disease status post automatic implantable cardioverter defibrillator (AICD) for congestive heart failure presented with suspected bacterial endocarditis and AICD lead infection from an outside hospital (OSH). The patient initially presented to the OSH with chest wall tenderness, fevers up to 101° F, chills, decreased appetite, weakness and weight loss. She was diagnosed with a non-ST segment myocardial infarction based on elevated troponin levels without electrocardiogram changes. At the OSH, blood acid fast bacillus (AFB) cultures were checked after routine blood cultures and fungal cultures …

A 55-Year-Old Man With Rapid Onset Rectosigmoid Mass And Hepatic Metastases With An Afp Of > 3 Million Ng/Ml, Francis Kim, Md

The Medicine Forum

Case

A 55-year-old male with a past medical history of ulcerative colitis diagnosed in 1999, Barrett’s esophagus, hyperlipidemia, and diabetes mellitus presented with a 2-week duration of daily constant abdominal pain. He described the pain as a sharp, epigastric pain not worsened with food intake or bowel movements. He was unable to tolerate any oral intake for a week prior to admission secondary to increased epigastric pain. He stated an increase in bowel movements to 1 per day that was softer and less formed than usual. He also stated he had a near syncopal episode on the day of admission …

Not Your Typical Case Of Ascites: Pancreatic Ascites In A Patient With Cirrhosis And Pancreatic Duct Leak, Philip Montemuro, Md, Abhik Roy, Md

The Medicine Forum

Case

A 55-year-old male with a history of hepatic cirrhosis secondary to Hepatitis C and alcohol abuse presented to an outside hospital with progressive abdominal pain and distension. The patient initially complained of “punching” right upper quadrant and epigastric abdominal pain that was 10/10 in intensity and non-radiating. Although the pain had started one to two days prior to presentation, the patient had been experiencing several weeks of increasing abdominal distension. He reported drinking eight 40oz beers daily for over 40 years, and he felt that the abdominal pain improved slightly with cessation of alcohol use. The patient complained of …