Medicine and Health Sciences Commons^™

Strongyloides Stercoralis Infection In A Patient With Aids, Abhik Roy, Md, Gregory Young, Md, Geoffrey Koff, Md, Tasha Kouvatsos, Md

The Medicine Forum

Case

A 46-year-old male with a past medical history significant for acquired immune deficiency syndrome (AIDS) presented with constant, non-radiating epigastric pain, nausea, non-bloody emesis, weakness, and lethargy. He had emigrated from Honduras twenty years prior. The patient denied fever, chills, recent travel, animal exposures, or sick contacts. His medications included efavirenz/emtricitabine/tenofovir, valganciclovir, trimethoprim/sulfamethoxazole, fluconazole, and iron.

Large, Solitary, High-Grade Duodenal Tubular Adenoma In A Patient Presenting With Gi Bleed, Paurush Shah, Md

The Medicine Forum

Case

A 71-year-old male with past medical history of hypertension, hyperlipidemia, aortic stenosis, and atrial flutter on warfarin presented to his primary care physician (PCP) a few days prior to admission with complaints of lethargy, lightheadedness, and mild shortness of breath (SOB) for about five days prior to admission. He stated that he had also been experiencing dark stools for one week while therapeutic on warfarin. His blood pressure in the office was slightly low, and he was told drink extra fluids as his symptoms were likely due to dehydration. The patient returned to his PCP a few days later …

An Indonesian Male With Abdominal Pain And Weight Loss: Abdominal Tuberculosis Presenting With Cervical Lymph Node Enlargement, Leah Duke Kaye, Md, Jayne Littlejohn, Md

The Medicine Forum

Case

A 21-year-old Indonesian male presented with a 6-month history of abdominal pain. The pain was described as a diffuse cramping that was worse with movement and after meals. He reported early satiety, and the pain was improved at rest. Associated with the pain, he reported a seventy pound weight loss, chills, decreased energy, and fatigue over the same time period. He denied nausea, vomiting, fevers, cough, dyspnea, or chest pain.

The patient emigrated from Indonesia to the United States in 2007 and has since had no travel or foreign visitors. He denied incarceration or military duty for both himself …

Hematemesis, A Distended Abdomen, And Pulseless Electrical Activity – An Unusual Presentation Of Boerhaave’S Syndrome, Andrew Garrett, Md, Marie Nguyen, Md, Lindsay Wilde, Md, Andrew Toscano, Md, Philip Pancari, Md, Andrew Lerner, Md

The Medicine Forum

Case Presentation

An 82-year-old male with a past medical history significant for coronary artery disease with three stents placed over the last 15 months, diastolic heart failure with preserved EF, atrial fibrillation on warfarin, colon cancer status-post sigmoid resection and prostate cancer status-post prostatectomy who presented with three episodes of melena, hematemesis, and weakness. The patient was in his usual state of health prior to these symptoms. He had no history of gastrointestinal (GI) bleeding or other GI pathology and was a non-drinker and non-smoker. He denied frequent use of non-steroidal anti-inflammatory medications.

Non-St Elevation Mi As A Unique Presentation Of Angioimmunoblastic T-Cell Lymphoma, Paurush Shah, Md, Gunjan Shah, Md, Avinash Chandra, Md, Lawrence Lee, Msiv, Gregary Marhefka, Md

The Medicine Forum

Case

A 61-year-old Chinese female with a history of hypertension, hyperlipidemia, asthma, and gastroesophageal reflux disease presented with four days of chest pressure that radiated to her left arm and jaw. On exam, her vital signs were within normal limits and cardiac and pulmonary exams were unremarkable. Her initial electrocardiogram (ECG) demonstrated ischemic ST segment depressions in leads II, III, and aVF; her first troponin I was elevated at 2.3 ng/mL (normal <0.05 ng/mL) and peaked at 6.8 ng/mL. She was given sublingual nitroglycerin and metoprolol, which controlled her symptoms, and she was started on a heparin infusion to prevent further ischemia. The patient’s medications included: amlodipine was notable for the following daily medications: amlodipine 5 mg, olmesartan 20mg, atorvastatin 20mg, esomeprazole 20mg, montelukast 10mg, and mometasone 110mcg twice daily. Her family history was significant for a brother who had a coronary stent placed at age 57. She denied drug, tobacco, or alcohol use. She was non-English speaking, and immigrated to the United States from China five years ago.

A 47-Year-Old Female With Shortness Of Breath, Dana Marrero, Md, Kelly Wright, Md

The Medicine Forum

This patient is a 47-year-old female with a history of end-stage liver disease secondary to hepatitis C virus (HCV) complicated by hepatic encephalopathy, obstructive sleep apnea, asthma, and severe peripheral neuropathy who presents to the hospital with complaints of shortness of breath and cough. The patient was recently discharged from an outside hospital 2 days prior to this admission where she was treated for pneumonia and an asthma exacerbation but her symptoms have not improved. She complains of shortness of breath at rest and severely decreased exercise tolerance with dyspnea while walking across the room. Her cough is persistent and …

Table Of Contents, The Medicine Forum, Volume 13, 2011

The Medicine Forum

Table of Contents, The Medicine Forum, Volume 13, 2011

A Case Series Of Lyme Carditis With Complete Heart Block, Rina Shah, Md, Mitul Kanzaria, Md

The Medicine Forum

Case 1

A 25-year-old Caucasian male with a history of a benign functional heart murmur presented to the emergency department for evaluation of 10 days of dyspnea with minimal exertion, such as walking a few blocks or climbing a flight of steps. Dyspnea was accompanied by moderate, dull, left-sided chest pain, which had been progressively worsening over the previous 3-5 days. The symptoms initially occurred only with exertion, but progressed to last 30-45 minutes after discontinuation of activity. He also noticed palpitations during these episodes, but did not try any remedies for his symptoms. Of note, two weeks prior to …

From The Editors, Andrew Lerner, Md, Tasha Kouvatsos, Md, Andrea Fennelly, Md

The Medicine Forum

The editorial staff would like to acknowledge the support of Dr. Diemer and Dr. Kane in producing this year’s Jefferson Forum. We appreciate your guidance and thank you for all that you have done to help bring this issue to print. We would also like to thank our internal medicine resident colleagues for contributing interesting and unique case reports, review articles, original research, travel experiences, and poetry. This issue of the Jefferson Forum could not have been done without your hard work and enthusiasm.

From The Desk Of The Residency Program Director, Gretchen Diemer, Md, Facp

The Medicine Forum

To the Friends of the Department of Medicine:

I am honored to be given the opportunity to lead this talented group of residents as they travel down the path toward completion of their residency training. On September 1st, Dr. Gregory Kane took the reins as the Interim Chair of the Department of Medicine here at Jefferson. A new Program Director could not ask for a more staunch supporter of education to occupy that role than Dr. Kane.

This edition of The Forum showcases the broad variety of patients our residents and students encounter during their training. The submissions to this …

Brief Report: A Phase Ii "Window-Of-Opportunity" Frontline Study Of The Mtor Inhibitor, Temsirolimus Given As A Single Agent In Patients With Advanced Nsclc, An Ncctg Study, Nicholas F. Reuter Md

Articles

BACKGROUND:

In an effort to evaluate the single agent activity of temsirolimus in previously untreated non-small-cell lung cancer, the North Central Cancer Treatment Group undertook a frontline "window-of-opportunity" study.

METHODS:

Patients received 25 mg of temsirolimus administered intravenously as a weekly 30 minute infusion, on a 4-week cycle. Based on a two-stage Fleming design, the treatment would be promising if at least four of the first 25 evaluable patients in stage I or at least six of the 50 evaluable patients at the end of stage II have a confirmed response. Fresh tumor biopsies were obtained to evaluate predictive markers …

Skeletal And Dental Components Of Class Ii Division 1 Correction With The Mara Compared To The Standard Edgewise Appliance, Zachary Paul Pitcher

Theses and Dissertations (ETD)

Many tools are available to correct Class II dental relationships. A functional orthopedic appliance is a popular type of Class II corrector that is thought to correct Class II dental relationships both dentally and skeletally by enhancing mandibular growth. The purpose of the study was to quantify differences in the amounts of skeletodental change based on treatment (MARA and Standard Edgewise) in Class II Division 1 patients. The sample consisted of 2 groups of Class II Division 1 patients: 51 patients treated with the MARA followed by an Edgewise appliance and another group of 51 patients treated with the Standard …

Frequency Weighting For Vibration-Induced White Finger Compatible With Exposure-Response Models., Anthony J. Brammer

UCHC Articles - Research

An analysis has been performed to derive a frequency weighting for the development of vibration-induced white finger (VWF). It employs a model to compare health risks for pairs of population groups that are selected to have similar health outcomes from operating power tools or machines with markedly different acceleration spectra (rock drills, chain saws, pavement breakers and motorcycles). The model defines the Relative Risk, RR_f(trial), which is constructed from the ratio of daily exposures and includes a trial frequency weighting that is applied to the acceleration spectra. The trial frequency weighting consists of a frequency-independent primary frequency range, …

Deciphering Phosphotyrosine-Dependent Signaling Networks In Cancer By Sh2 Profiling, Kazuya Machida

UCHC Articles - Research

It has been a decade since the introduction of SH2 profiling, a modular domain-based molecular diagnostics tool. This review covers the original concept of SH2 profiling, different analytical platforms, and their applications, from the detailed analysis of single proteins to broad screening in translational research. Illustrated by practical examples, we discuss the uniqueness and advantages of the approach as well as its limitations and challenges. We provide guidance for basic researchers and oncologists who may consider SH2 profiling in their respective cancer research, especially for those focusing on tyrosine phosphoproteomics. SH2 profiling can serve as an alternative phosphoproteomics tool to …

A Bayesian Approach To Pathway Analysis By Integrating Gene–Gene Functional Directions And Microarray Data, David W. Rowe, Yifang Zhao, Ming-Hui Chen, Dong-Guk Shin, Lynn Kuo

UCHC Articles - Research

Many statistical methods have been developed to screen for differentially expressed genes associated with specific phenotypes in the microarray data. However, it remains a major challenge to synthesize the observed expression patterns with abundant biological knowledge for more complete understanding of the biological functions among genes. Various methods including clustering analysis on genes, neural network, Bayesian network and pathway analysis have been developed toward this goal. In most of these procedures, the activation and inhibition relationships among genes have hardly been utilized in the modeling steps. We propose two novel Bayesian models to integrate the microarray data with the putative …

Long Distance Electron Transfer Across >100 Nm Thick Au Nanoparticle/Polyion Films To A Surface Redox Protein, James F. Rusling, Hongyun Liu, Yasemin Kutes, Bryan D. Huey

UCHC Articles - Research

Glutathione-decorated 5 nm gold nanoparticles (AuNPs) and oppositely charged poly(allylamine hydrochloride) (PAH) were assembled into {PAH/AuNP}_n films fabricated layer-by-layer (LbL) on pyrolytic graphite (PG) electrodes. These AuNP/polyion films utilized the AuNPs as electron hopping relays to achieve direct electron transfer between underlying electrodes and redox proteins on the outer film surface across unprecedented distances >100 nm for the first time. As film thickness increased, voltammetric peak currents for surface myoglobin (Mb) on these films decreased but the electron transfer rate was relatively constant, consistent with a AuNP-mediated electron hopping mechanism.

Time-Series Model To Predict Impact Of H1n1 Influenza On A Children's Hospital., Michael C. Spaeder, Jonathan R. Stroud, Xiaoyan Song

Pediatrics Faculty Publications

The spring of 2009 witnessed the emergence of a novel influenza A(H1N1) virus resulting in the first influenza pandemic since 1968. In autumn of 2010, the 2009 novel H1N1 influenza strain re-emerged. We performed a retrospective time-series analysis of all patients with laboratory-confirmed H1N1 influenza who presented to our institution during 2009. Cases of influenza were assembled into 3-day aggregates and forecasting models of H1N1 influenza incidence were created. Forecasting estimates of H1N1 incidence for the 2010–2011 season were compared to actual values for our institution to assess model performance. Ninety-five percent confidence intervals calculated around our model's forecasts were …

Medical Education Digest, Vol. 14 No. 3 (May/June 2012), Nova Southeastern University

Medical Education Digest

No abstract provided.

The End Of Nowhere: The History Of Tuberculosis In Ri, Emma G. Sconyers

Senior Honors Projects

The World Health Organization estimates that approximately one third of the word's current population had been infected with tuberculosis. Prior to the 1940's TB was considered an incurable, chronic affliction. Historically, many people were forcibly detained in tuberculosis sanatoria to lessen the spread of the disease; my great granfather being one of them. In 1939, without warning, he was taken from his pregnant, jobless wife and one-year-old daughter, who were left to fend for themselves for two years without government planning or assistance. He spent those two years at Wallum Lake Sanitorium in northern Rhode Island, a place my great-grandmother's …

A Mathematical Model For Dengue Fever In A Virgin Environment, Jason K. Bowman

Senior Honors Projects

Dengue is a mosquito-borne viral infection found in tropical and subtropical regions around the world. The disease was named in 1779 and the first recorded epidemic of it occurred simultaneously on three continents within the following decade. Dengue is characterized by flu-like symptoms and, while its symptoms are generally reported as quite unpleasant, is rarely fatal. However, in some cases patients can contract a more serious form of the disease, known as Dengue Hemorrhagic Fever, which is far more dangerous. The World Health Organization estimates that today over 2.5 billion people are at risk for Dengue (over 40% of the …

Differences In Substance-Related Risk Behavior Between Dual And Triple Diagnosed Severely Mentally Ill Adults, Michelle Hampton, Linda Chafetz, Carmen Portillo

Faculty Publications

No abstract provided.

Elevated Plasma Il-6 Associates With Increased Risk Of Advanced Fibrosis And Cholangiocarcinoma In Individuals Infected By Opisthorchis Viverrini, Banchob Sripa, Bandit Thinkhamrop, Eimorn Mairiang, Thewarach Laha, Sasithorn Kaewkes, Paiboon Sithithaworn, Maria V. Periago, Vajarabhongsa Bhudhisawasdi, Ponlapat Yonglitthipagon, Jason Mulvenna, Paul J. Brindley, Alex Loukas, Jeffrey M. Bethony

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Opisthorchis viverrini is considered among the most important of the food-borne trematodes due to its strong association with advanced periductal fibrosis and bile duct cancer (cholangiocarcinoma). We investigated the relationship between plasma levels of Interleukin (IL)-6 and the risk of developing advanced fibrosis and bile duct cancer from chronic Opisthorchis infection. We show that IL-6 circulates in plasma at concentrations 58 times higher in individuals with advanced fibrosis than age, sex, and nearest-neighbor matched controls and 221 times higher in individuals with bile duct cancer than controls. We also observed a dose-response relationship between increasing levels of plasma IL-6 and …

Bmi-Mortality Paradox And Fitness In African American And Caucasian Men With Type 2 Diabetes, Peter Kokkinos, Jonathan Myers, Charles Faselis, Michael Doumas, Raya Kheirbek, Eric Nylen

Medicine Faculty Publications

OBJECTIVE

To assess the association between BMI, fitness, and mortality in African American and Caucasian men with type 2 diabetes and to explore racial differences in this association.

RESEARCH DESIGN AND METHODS

We used prospective observational data from Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, California. Our cohort (N = 4,156; mean age 60 ± 10.3 years) consisted of 2,013 African Americans (mean age, 59.5 ± 9.9 years), 2,000 Caucasians (mean age, 60.8 ± 10.5 years), and 143 of unknown race/ethnicity. BMI, cardiac risk factors, medications, and peak exercise capacity in metabolic equivalents (METs) were assessed …

Chattanooga Community Members Willingness To Use Retail Clinics: A Quantitative Approach, Yasmine M. Swistek, Casey M. Waddle

Graduate Research Projects

This study explored the willingness of Chattanooga community members to utilize retail clinics for simple ailments rather than the area EDs. Specifically, community members ages 25-45 were surveyed and asked to rate their willingness to use a retail clinic for their acute healthcare needs rather than the overcrowded local EDs. Additionally, this study explored community members’ perceived barriers to use retail clinics. Results were compared between demographic variables such as yearly income, race, gender, and age.

A Comparison Of Autonomous Regulation And Negative Self-Evaluative Emotions As Predictors Of Smoking Behavior Change Among College Students, Hyoung S. Lee, Delwyn Catley, Kari J. Harris

Public and Community Health Sciences Faculty Publications

This study compared autonomous self-regulation and negative self-evaluative emotions as predictors of smoking behavior change in college student smokers (N=303) in a smoking cessation intervention study. Although the two constructs were moderately correlated, latent growth curve modeling revealed that only autonomous regulation, but not negative self-evaluative emotions, was negatively related to the number of days smoked. Results suggest that the two variables tap different aspects of motivation to change smoking behaviors, and that autonomous regulation predicts smoking behavior change better than negative self-evaluative emotions.

The Meaning Of Parenteral Hydration To Family Caregivers And Patients With Advanced Cancer Receiving Hospice Care., Marlene Z. Cohen, Isabel Torres-Vigil, Beth E. Burbach, Allison De La Rosa, Eduardo Bruera

Journal Articles: College of Nursing

CONTEXT: In the U.S., patients with advanced cancer who are dehydrated or have decreased oral intake almost always receive parenteral hydration in acute care facilities but rarely in the hospice setting.

OBJECTIVES: To describe the meaning of hydration for terminally ill cancer patients in home hospice care and for their primary caregivers.

METHODS: Phenomenological interviews were conducted at two time points with 85 patients and 84 caregivers enrolled in a randomized, double-blind, controlled trial examining the efficacy of parenteral hydration in patients with advanced cancer receiving hospice care in the southern U.S. Transcripts were analyzed hermeneutically by the interdisciplinary research …

Substrate Use And Biochemical Response To A 3,211-Km Bicycle Tour In Trained Cyclists, Dustin R. Slivka, Charles Dumke, Walter S. Hailes, John S. Cuddy, Brent Ruby

Integrative Physiology and Athletic Training Faculty Publications

The purpose of this study was to assess the physiological adaptations in physically fit individuals to a period of intensified training. Ten trained males cycled outdoors ~170 km day⁻¹ on 19 out of 21 days. Expired gas was collected on days 1 and 21 during maximal graded exercise and used for the determination of gross efficiency and whole body substrate use. Muscle biopsies were obtained before and after exercise on days 2 and 22 for the determination of mtDNA/gDNA ratio, gene expression, metabolic enzyme activity and glycogen use. Muscle glycogen before and after exercise, fat oxidation, and gross efficiency …

New Hampshire Public Mental Health Consumer Survey Project: Summary Of Findings May 2012, Peter Antal

Institute on Disability

No abstract provided.

Using Physiologically-Based Pharmacokinetic Models To Incorporate Chemical And Non-Chemical Stressors Into Cumulative Risk Assessment: A Case Study Of Pesticide Exposures, Susan C. Wason, Thomas J. Smith, Melissa J. Perry, Jonathan I. Levy

Environmental and Occupational Health Faculty Publications

Cumulative risk assessment has been proposed as an approach to evaluate the health risks associated with simultaneous exposure to multiple chemical and non-chemical stressors. Physiologically based pharmacokinetic/pharmacodynamic (PBPK/PD) models can allow for the inclusion and evaluation of multiple stressors, including non-chemical stressors, but studies have not leveraged PBPK/PD models to jointly consider these disparate exposures in a cumulative risk context. In this study, we focused on exposures to organophosphate (OP) pesticides for children in urban low-income environments, where these children would be simultaneously exposed to other pesticides (including pyrethroids) and non-chemical stressors that may modify the effects of these exposures …

Suicide Rates Among Young, Married Women In Nepal, Kirra L. Hughes

Capstone Collection

In 2009, a Maternal Mortality and Morbidity (MMM) report carried out in Nepal by the Family Health Division of the Department of Health Services accidently stumbled upon a surprising leading cause of death in Nepali women of reproductive age (15 - 49). The result: suicide. And the numbers are still on the rise. There have since been no comprehensive follow-up studies and none, to my knowledge, that are currently ongoing. This leaves an urgent need for research to be done on the causes of these suicides (Benson and Shakya, 2011; Bertolote et al, 2005; Pradhan et al, 2009).

Globally, there …