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Ada News - 07/13/2015, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

New York State: Comparison Of Treatment Outcomes For Unruptured Cerebral Aneurysms Using An Instrumental Variable Analysis, Kimon Bekelis, Symeon Missios, Shannon Coy, Robert J. Singer, Todd A. Mackenzie

Dartmouth Scholarship

Background:

There is wide regional variation in the predominant treatment for unruptured cerebral aneurysms. We investigated the association of elective surgical clipping and endovascular coiling with mortality, readmission rate, length of stay, and discharge to rehabilitation.

Methods and Results:

We performed a cohort study involving patients with unruptured cerebral aneurysms, who underwent surgical clipping or endovascular coiling from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System database. An instrumental variable analysis was used to investigate the association of treatment technique with outcomes. Of the 4643 patients undergoing treatment, 3190 (68.7%) underwent coiling, and 1453 …

A Modified Potency Test Strategy For Iv Admixtures Prepared By Robotic Systems, Fang Zhao, Vivek S. Dave, Susan E. Hughes

Pharmacy Faculty/Staff Publications

Introduction:

Robotic systems are increasingly used for compounding sterile IV admixtures (1-5). In addition to routine gravimetric checks, initial and periodic drug potency analysis by high-performance liquid chromatography (HPLC) is desired to verify the system accuracy. However, the conventional HPLC test procedures often result in unexpected failures (1-2).

This study was initiated to develop a modified HPLC test strategy to eliminate the common source of variability and focus the effort on the accuracy of robotic system.

Defining "Independent Practice" For Nurse Practitioners In The State Of Texas: Envisioning A Workable Model, Hines Ann Tracy

Nursing Theses and Dissertations

Health care reform, an aging population, and a decreasing primary care physician workforce has resulted in questioning of primary health care delivery in the United States. Nurse practitioners are being viewed as the possible answer to primary health care provider deficiencies. This advanced practice role, initially developed in the 1960s, has been shown to be an effective, cost efficient alternative to the medical model of health care delivery. Nurse practitioners' licensure and practice are regulated by each individual state resulting in state-to-state variances in the role. This inconsistency leads to further questions regarding the nurse practitioner role and practice independence. …

Comorbidities And Quality Of Life Among Breast Cancer Survivors: A Prospective Study, Mei R. Fu, Deborah Axelrod, Amber A. Guth, Charles M. Clel, Caitlin E. Ryan, Kristen R. Weaver-Toedtman Phd, Acnp, Anp, Jeanna M. Qiu, Robin Kleinman, Joan Scagliola, Joseph J. Palamar, Gail D’Eramo Melkus

Publications

Many breast cancer survivors have coexistent chronic diseases or comorbidities at the time of their cancer diagnosis. The purpose of the study was to evaluate the association of comorbidities on breast cancer survivors’ quality of life. A prospective design was used to recruit 140 women before cancer surgery , 134 women completed the study . Comorbidities were assessed using self-report and verified by medical record review and the Charlson Comorbidity Index (CCI) before and 12-month after cancer surgery . Quality of life was evaluated using Short-Form Health Survey (SF -36 v2) . Descriptive statistics, chi-square tests, t-tests, Fisher’s exact test, …

Evaluating The Validity Of Self-Reported Smoking In Mexican Adolescents, María Del Carmen Valladolid-López, Tonatiuh Barrientos-Gutiérrez, Luz Myriam Reynales-Shigematsu, Jim Thrasher, Ingris Peláez-Ballestas, Eduardo Lazcano-Ponce, Mauricio Hernández-Ávila

Faculty Publications

Objectives We aimed to evaluate the validity of the self-reported smoking indicator used in the Global Youth Tobacco Survey (GYTS).

Setting 43 middle and high-school classrooms from 26 schools were selected from Mexico City and Cuernavaca, Morelos.

Participants A total of 1257 students provided both a questionnaire and a urine sample.

Primary and secondary outcome Sensitivity and specificity of self-reported smoking compared to urinary cotinine. Validity indices were evaluated by subgroups of gender, social acceptability of smoking (ie, smoking parents or friends) and smoking frequency.

Results Sensitivity and specificity for current smoking were 93.2% and 81.7%, respectively. Validity indices remained …

Dumbbell-Pcr: A Method To Quantify Specific Small Rna Variants With A Single Nucleotide Resolution At Terminal Sequences., Shozo Honda, Yohei Kirino

Computational Medicine Center Faculty Papers

Recent advances in next-generation sequencing technologies have revealed that cellular functional RNAs are not always expressed as single entities with fixed terminal sequences but as multiple isoforms bearing complex heterogeneity in both length and terminal sequences, such as isomiRs, the isoforms of microRNAs. Unraveling the biogenesis and biological significance of heterogenetic RNA expression requires distinctive analysis of each RNA variant. Here, we report the development of dumbbell PCR (Db-PCR), an efficient and convenient method to distinctively quantify a specific individual small RNA variant. In Db-PCR, 5'- and 3'-stem-loop adapters are specifically hybridized and ligated to the 5'- and 3'-ends of …

Medical School Watercooler Newsletter - July 12, 2015, Lindsey Lyle

Watercooler Newsletter

This is the July 12, 2015 edition of the Frederick P. Whiddon College of Medicine's Newsletter - Watercooler.

Contents Include:

Grant Award Allows for Creation of NICU Family Resource Center

USA Center for Healthy Communities Center of Excellence Hosts Regional Health Disparities Symposium

USA Medical Student Returns From NIH Medical Research Scholars Program

Tobacco Cessation: Why Quit?

Purchasing And Using Personal Emergency Response Systems (Pers): How Decisions Are Made By Community-Dwelling Seniors In Canada, Alexandra C. Mckenna, Marita Kloseck, Richard Crilly, Jan Polgar

Bone and Joint Institute

© 2015 McKenna et al. Background: As the demographic of older people continues to grow, health services that support independence among community-dwelling seniors have become increasingly important. Personal Emergency Response Systems (PERS) are medical alert systems, designed to serve as a safety net for seniors living alone. Health care professionals often recommend that seniors in danger of falls or other medical emergencies obtain a PERS. The purpose of the study was to investigate the experience of seniors living with and using a PERS in their daily lives, using a qualitative grounded theory approach. Methods: Five focus groups and 10 semi-structured …

Formulation And In Vivo Evaluation Of Aliskiren-Loaded Poly(Lactic-Co-Glycolic) Acid Nanoparticles, Derek E. Murrell, Jessica M. Coleman, Stacy D. Brown, Sam Harirforoosh

Pharmacy Faculty Articles and Research

Aliskiren (ALS) is a direct renin inhibitor with low bioavailability and high drug cost. The goal of this study was to increase the bioavailability of ALS through nanoformulation. The optimized formulation was then evaluated in spontaneously hypertensive rats (SHRs). We developed an ALS poly(lactic-co-glycolic) acid nanoparticle (ALS-NP) through the emulsion–diffusion–evaporation method with various solvents, stabilizer concentrations, and centrifugation speeds. SHRs were orally dosed with 30 mg/kg ALS or dose equivalent ALS-NP. Several parameters were assayed in plasma and/or urine at baseline and 24 h post-dose, while pharmacokinetic analysis included serial sampling. The optimum formulation was found with ethyl acetate, a …

Low And Moderate Prenatal Ethanol Exposure Of Mice During Gastrulation Or Neurulation Delays Neurobehavioral Development, Uta B. Schambra, Jeff Goldsmith, Kevin Nunley, Yali Liu, Sam Harirforoosh, Heidi M. Schambra

Pharmacy Faculty Articles and Research

Human and animal studies show significant delays in neurobehavioral development in offspring after prolonged prenatal exposure to moderate and high ethanol doses resulting in high blood alcohol concentration (BECs). However, none have investigated the effects of lower ethanol doses given acutely during specific developmental time periods. Here, we sought to create a mouse model for modest and circumscribed human drinking during the 3rd and 4th weeks of pregnancy.

We acutely treated mice during embryo gastrulation on gestational day (GD) 7 or neurulation on GD8 with a low or moderate ethanol dose given via gavage that resulted in BECs of 107 …

Download Entire Issue Of The Medicine Forum, Volume 15, 2013-2014

The Medicine Forum

Download entire issue of The Medicine Forum, Volume 15, 2013-2014

Stay, Jennifer Alloo Hong, Md

The Medicine Forum

As an intern, I thought of myself as the member of the team who gets the things done. I took pride in prioritizing my long list of tasks and efficiently working through each item. I spent most of my time at the computer, on the phone, in front of the chart, or in a consultant’s office. My time with patients was so limited that I grew more comfortable thinking about their medical problems away from their bedside.

Swyer-James-Mcleod Syndrome, Esther Molnar, Md, Arun Matthew, Md

The Medicine Forum

Admission chest x-ray of an 81 year-old man admitted to the hospital for atrial fibrillation with rapid ventricular response is shown in Figure 1. The chest x-ray shows a unilateral hyperlucent lung, with paucity of peripheral vessels and decreased lung volume. Differential diagnosis for unilateral hyperlucent lung includes Swyer-James-McLeod syndrome (SJMS), centrilobular emphysema, allergic bronchopulmonary aspergillosis, congenital lobar over inflation, bronchial atresia and congenital interruption of pulmonary artery.1 High resolution CT imaging confirmed the diagnosis of SJMS in this patient.

Pyoderma Gangrenosum Associated With Acute Myelogenous Leukemia, Lekha Mikkilineni, Md, Aishah Ali, Md

The Medicine Forum

A 20-year-old man presented with a non-healing ulcer on the dorsum of the left foot that initially appeared after the patient fell and hit his left foot on the edge of a door. An ulcer had formed and grown in size over the past several weeks after repeated physical insults and despite home wound care, as seen in Figure 1. Additionally, the patient had a non-healing ulcer inferior to his left knee. He had a notable past medical history of acute myelogenous leukemia (AML) in remission after a haploidentical stem cell transplant, uncontrolled diabetes type 1, and graft-versus-host disease of …

Tb, Or Not Tb?, Michael A. Valentino, Md, Phd

The Medicine Forum

The patient is a 43-year-old African American male with a past medical history of hypertension, hyperlipidemia, and chronic low back pain who presented to the ER for worsening dyspnea and a 30-lb weight loss over the past 3 months. He also reported a nonproductive cough over this period of time as well as an eruption of small ~1cm flesh-colored nodules on his extremities and trunk. He denied any fevers, chills, or night sweats. In the ER, he had a chest x-ray performed (Figure 1) which showed diffuse centrilobular nodules visualized throughout the lung fields in a miliary pattern. He subsequently …

Technique For Safe Placement Of A Dobhoff Tube Without A Cortrak® Machine, Jon Chao, Md, Jennifer Alloo Hong, Md

The Medicine Forum

A 58 year old female with a history of end stage renal disease on hemodialysis, insulin dependent diabetes mellitus, ischemic cardiomyopathy, and adrenal insufficiency, presented from home with altered mental status and hypotension. She developed refractory hypotension requiring vasopressors and was admitted to the medical ICU for management of septic shock due to bacterial peritonitis. She was intubated and had an oro-gastric tube placed for enteral nutrition. However, significantly elevated gastric residuals developed secondary to delayed gastric emptying. We decided to place a post-pyloric Dobhoff tube as an alternative gastric access to continue enteral feeding. Since a Cortrak machine (an …

A Case Of Body Packing: Internal Smuggling Of Illicit Drugs, Michael A. Valentino, Md, Phd

The Medicine Forum

The patient is a 27-year old Hispanic female who was brought to the ER from the airport by the Drug Enforcement Agency (DEA) on suspicion of “body packing” (illicit drug smuggling via ingestion). An abdominal X-ray (Figures 1a,b) was obtained in the ER which showed multiple radiopaque foreign bodies which were uniform in size measuring 5 cm x 2 cm throughout her colon. The patient then admitted to ingesting numerous heroin pellets. She subsequently had a CT Abdomen/Pelvis performed (Figure 2) which again showed numerous tubular radiopaque foreign bodies throughout the gastrointestinal tract. She was admitted to the medical intensive …

A Case Of Fanconi’S Syndrome In A Patient With Hiv, Mariam Kabir, Md, Phd, Christopher Miller, Md, Rakesh Gulati, Md, Mrcp, William R. Short, Md, Mph

The Medicine Forum

Introduction

Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue reverse transcriptase inhibitor (NtRTI), which blocks reverse transcriptase, an enzyme found in HIV. Since its approval for use in HIV by the FDA in 2001, it has contributed to effective treatment in numerous patients. The most common side effects include nausea, vomiting, diarrhea, asthenia, abdominal pain and hepatotoxicity. A less common side effect is nephrotoxicity leading to Fanconi’s syndrome. Here is an interesting case of Fanconi’s Syndrome caused by Tenofovir.

Case

A 50-year-old Caucasian female with a past medical history of HIV and Hepatitis C presented to the Emergency Department with …

A Case Of Septic Portal Vein Thrombosis (Pylephlebitis), Erin Carnish, Md, Andrew Garrett, Md, Mary Slome, Ms1

The Medicine Forum

INTRODUCTION

Pylephlebitis, defined as suppurative thrombosis of the portal vein often associated with bacteremia, is a rare and serious complication of intra-abdominal infections. Prior to antibiotics, the mortality rate of this disease approached 100%.1 The veins adjacent to the infection are the first to be involved, with later spread to the portal vein and possibly the mesenteric and splenic veins.2-3 Extension into the mesenteric veins can lead to bowel necrosis and increased morbidity and mortality.2-4

CASE PRESENTATION

A 63-year old male with a history of hypertension presented to the emergency department with one week of progressively worsening malaise, chills, severe …

Hepatitis C Therapy: Serendipitous Successes, Apeksha Shah, Md, Jonathan Fenkel, Md

The Medicine Forum

Introduction

Hepatitis C virus (HCV) infection is a growing epidemic worldwide, with about 170 million cases reported by 2011.1 New therapies have been introduced to the market, but the prior mainstay of therapy involves pegylated interferon-alpha (IFN) along with ribavirin (RBV).2 Treatment with the first generation direct-acting antiviral agent-containing regimens consisted of at least 24 weeks of therapy, with the goal of sustained viral response (SVR) – no detectable virus 24 weeks after treatment is completed. We report two cases in which therapy was terminated early due to the developed of severe infection, yet the patients still achieved SVR.

Case …

A Case Of Complete Heart Block Secondary To Anca-Associated Vasculitis, Krista Lim-Hing, Md

The Medicine Forum

INTRODUCTION

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides are systemic autoimmune diseases that often present as non-specific prodromal symptoms such as fever, fatigue, headache, and weight loss.1 With modern treatment, the disease has changed from being universally fatal to being treatable. It can have a chronic relapsing and remitting course. Therefore, early diagnosis is necessary.2,3

CASE PRESENTATION

A 53-year-old male with a past medical history of chronic sinusitis and some epistaxis needing multiple courses of antibiotics and steroids, was admitted after being diagnosed with high-grade heart block at another institution. He was found to have a heart rate of 26 and …

An Unusual Atrial Mass: A Case Study, David F. Reilly, Bs, Christina Lindenmeyer, Md

The Medicine Forum

BACKGROUND

This case highlights the evolution of a broad differential diagnosis when presented with a rare and diagnostically enigmatic clinical finding.

Recurrent Unilateral Pleural Effusion From Constrictive Pericarditis Of Unknown Etiology Requiring Pericardiectomy, Aishah Ali, Md, Gina Keiffer, Md

The Medicine Forum

Introduction

Constrictive pericarditis is an uncommon cause of unilateral pleural effusion. In patient’s who have repeated thoracenteses with no obvious cause for the pleural effusion, constrictive pericarditis should be considered. Right and left heart catheterization is used to diagnosis constrictive pericarditis by measuring filling pressures of the heart.

Case Report

A 52-year-old man with a history of hepatitis C, hepatocellular carcinoma (HCC), status post liver transplant in July 2013, chronic kidney disease, gastroesophageal reflux disease and hypothyroidism presented with increasing dyspnea with minimal exertion and was found to have recurrent pleural effusion. Patient had been worked up as an outpatient …

A Rare Case Of Tumor Lysis Syndrome, Anne Mainardi, Ms4, Daniel Okamoto, Md, Jianqing Lin, Md

The Medicine Forum

INTRODUCTION

Tumor lysis syndrome (TLS) is a metabolic disturbance caused by the destruction of rapidly dividing cancer cells following administration of cytotoxic chemotherapy. The subsequent release of intracellular material results in hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.1 The clinical presentation of TLS, including acute kidney injury, results from these electrolyte abnormalities and can be life-threatening.2 Here we present the second reported case of TLS in a woman with endometrial cancer.

CASE PRESENTATION

A 63 year old woman with newly-diagnosed endometrial cancer (International Federation of Gynecology and Obstetrics, FIGO, stage IVB) who received her first dose of carboplatin and paclitaxel four days …

Anomalous Left Main Coronary Artery Originating From The Right Sinus Of Valsalva, Silpa Yalamanchili, Ms4, Kevin M. Curl, Md

The Medicine Forum

Introduction

An anomalous left main coronary artery is a rarely seen clinical entity, particularly when it arises from the right sinus of Valsalva. This case report highlights this uncommon finding and how it affects the care of a patient with significant coronary artery disease.

Case Presentation

A 66 year-old male with a history of hypertension, hyperlipidemia, and type II diabetes presented with progressive exertional mid-epigastric and mid-chest discomfort. The patient stated that he had been feeling this “heaviness” with various activities and occasionally at rest for the past nine months. When it occurred with activity, the pain was generally relieved …

Interventricular Septum Rupture In The Catheterization Laboratory, Xing Zhang, Md, Loheetha Ragupathi, Md

The Medicine Forum

Introduction

This is a case of acute ventricular septal defect (VSD) that was diagnosed while a patient with an acute ST-elevation myocardial infarction (STEMI) was being treated in the cardiac catheterization laboratory. Post-MI VSD is a well-recognized complication of STEMI, and this case was particularly interesting given the circumstances of its diagnosis.

Case Presentation

A 75 year-old female with a history of well-controlled hypertension presented with 3 days of substernal chest pain radiating down her left arm. The pain was severe, unremitting, associated with shortness of breath, nausea, vomiting, and was not relieved by simethicone or by changes in position. …

Fever In A Man With Hiv: An Unusual Case Of An Immune System Gone Wrong, Emily Sutton, Md, Aishah Ali, Md

The Medicine Forum

Introduction

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of immune dysregulation that is often recognized as secondary to an underlying immune activating state, such as malignancy, rheumatologic disorders, and infections. This case highlights an association between HLH and human immunodeficiency virus (HIV) infection. Although HLH is a rare complication of HIV, it presents a difficult challenge for treatment. Without treatment, HLH is invariably fatal, but the consequence of the immunosuppressive treatment regimen in the setting of an underlying opportunistic infection can also have fatal outcomes.

Case Presentation

A 38 year-old man with a history of HIV infection with a CD4 …

Hiv Screening: A Review Of Nationally Recommended Guidelines And Specific Instances In Which Hiv Screening Is Often Overlooked, Anusha Ganesh, Md

The Medicine Forum

INTRODUCTION

According to the Centers for Disease Control and Prevention (CDC), one in five human immunodeficiency virus (HIV)-infected individuals are currently living without knowledge of their diagnosis.1 In 2006, the cost of a rapid HIV test with pre/post-test HIV counseling was anywhere between 48-64 US dollars (USD). The majority of the cost incurred was for HIV counseling, with the cost of the rapid HIV test being between 8-25 USD.2 Research looking at the cost-effectiveness of HIV screening shows that it is more cost-effective than routine screening for breast cancer with mammography yearly or even routine screening for diabetes mellitus with …

A Case Of Fibrosing Mediastinitis, Esther Molnar, Md

The Medicine Forum

Introduction

Fibrosing mediastinitis (FM) is a rare disease of slowly progressive fibrosis that encases major mediastinal structures. Complications include obstruction of mediastinal vasculature, including main pulmonary arteries, which may lead to life-threatening hemodynamic compromise. In North America, the disease is usually a sequela of histoplasmosis. Because Histoplasma capsulatum (H. capsulatum) is found in the Ohio River Valley, physicians in Pennsylvania must be able to recognize and diagnose the disease.

Case Presentation

The patient is a 59 year-old female who was seen for follow-up in April 2013. She originally presented to the outpatient office in 2008 with chronic chest pain and …